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Respiration. 2013;85(6):464-70. doi: 10.1159/000339346. Epub 2012 Aug 15.

Renal replacement therapy in patients with severe precapillary pulmonary hypertension with acute right heart failure.

Author information

1
Réanimation Médicale, Hôpital Antoine Béclère, AP-HP, Clamart, France. benjamin.sztrymf@abc.aphp.fr

Abstract

BACKGROUND:

Renal replacement therapy has been suggested as a therapeutic option in the setting of acute right ventricular failure in patients with severe precapillary pulmonary hypertension. However, there are few data supporting this strategy.

OBJECTIVES:

To describe the clinical course and the prognosis of pulmonary hypertensive patients undergoing renal replacement therapy in the setting of acute right heart failure.

METHODS:

This was a single-center retrospective study over an 11-year period. Data were collected from all patients with chronic precapillary pulmonary hypertension requiring catecholamine infusions for clinical worsening and acute kidney injury that necessitated renal replacement therapy.

RESULTS:

Fourteen patients were included. At admission, patients had a blood urea of 28.2 mmol/l (22.3-41.2), a creatinine level of 496 µmol/l (304-590), and a mean urine output in the 24 h preceding hospitalization of 200 ml (0-650). Sixty-eight renal replacement therapy sessions were performed, 36 of which were continuous and 32 of which were intermittent. Systemic hypotension occurred in 16/32 intermittent and 16/36 continuous sessions (p = 0.9). Two patients died during a continuous session. The intensive care unit-related, 1-, and 3-month mortality was 46.7, 66.7, and 73.3%, respectively.

CONCLUSION:

Renal replacement therapy is feasible in the setting of acute right ventricular failure in patients with severe precapillary pulmonary hypertension but is associated with a poor prognosis. The best modality and timing in this population remain to be defined.

PMID:
22906846
DOI:
10.1159/000339346
[Indexed for MEDLINE]
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