Value of clinical parameters in predicting the initiation of renal replacement therapy in acute kidney injury patients with cardiorenal syndrome / 中华肾脏病杂志

ABSTRACT

Objective To investigate the value of clinical parameters in predicting the initiation of renal replacement therapy(RRT) in acute kidney injury (AKI) patients with cardiorenal syndrome (CRS).Methods A total of 75 AKI patients hospitalized with CRS were enrolled.All patients received pharmacologic therapy on the beginning 3 days.The patients whose heart function improved were divided into control group (n=39),and the patients whose heart function worsened were divided into RRT group (n=36).Clinical and laboratory data on the first day and the fourth day were collected and analyzed.The factors on the first day were labeled asⅠ ,and those on the fourth day were labeled asⅡ. The ratio of some parameters calculated were labeled asⅡ/Ⅰ .Area under curve (AUC) of receiver operating characteristic curve (ROC) of these factors was used to evaluate the sensitivity and specificity in predicting the initiation of RRT.Results The patients in RRT group had significantly higher levels of BNP-Ⅱ,BNP Ⅱ / Ⅰ and creatinine Ⅱ / Ⅰ (P ＜ 0.01),and lower levels of 24 hours urine volume-Ⅰ and 24 hours urine volume-Ⅱ (P ＜ 0.01).From ROC curve analysis,the AUC of 24 hours urine volume-Ⅰ,24 hours urine volume-Ⅱ,creatinine Ⅱ / Ⅰ,BNP-Ⅱ levels and BNP Ⅱ/Ⅰ to predict RRT were 0.736,0.875,0.747,0.779 and 0.894 respectively.When the cutoff values of 24 hours urine volume-Ⅰ,24 hours urine volume-Ⅱ,BNP-Ⅱ levels,BNP Ⅱ / Ⅰ and creatinine Ⅱ / Ⅰ were 905 ml (sensitivity 75％,specificity 94.9％),1450 ml (sensitivity 75％,specificity 100％),3360 ng/L (sensitivity 72.2％,specificity 100％),1.37 (sensitivity 75％,specificity 100％) and 1.25 (sensitivity 72.2％,specificity 94.4％) respectively,the value of the parameters to predict RRT was high.Conclusions The 24 hours urine volume,BNP levels after treatment and the dynamic changes of BNP levels and creatinine levels can be used as predictors of the initiation of RRT in the AKI patients with CRS.