부산대학교 도서관

Continuous pump-driven veno-venous hemofiltration (CVVH) has become an established method for treatment of acute renal failure (ARF). Since severe disturbances of (micro-) circulation are intimately involved in the bad outcome of these patients, the profile of endocrinological regulators of circulation was prospectively and serially measured in patients undergoing pump-driven CVVH (n = 15). 15 patients with similar APACHE II score, but without ARF and without CVVH were also studied. Endothelin-1 (ET-1), atrial natriuretic peptide (ANP), vasopressin, renin, and catecholamine (epinephrine, norepinephrine) plasma levels were measured before start of CVVH (= “baseline”) (in the non-CVVH patients: admission to intensive care unit) and during the next 5 days. Various hemodynamic parameters were additionally monitored. MAP, HR, PAP, Cl, and right ventricular hemodynamics (RVEF, RVEDV, RVESV) remained almost unchanged in the CVVH patients and were without differences to the non-CVVH group within the entire investigation period. PCWP and RAP were higher in the CVVH patients already at baseline (RAP, 17.8 ± 4.0 mmHg; PCWP, 22.1 ± 4.5 mmHg) (p< .02) and remained elevated in the further course of the investigation. Renin plasma level was higher already at baseline in the CVVH patients (907 ± 184 pg/ml) (p< .05) and further increased during CVVH (to 1453 ± 186 pg/mL). Vasopressin increased only in the CVVH group (from 3.80 ± .66 to 11.85 = 1.05 pg/mL) (p< .01). Plasma catecholamines were higher in the CVVH than in the non-CVVH patients already at the beginning (epinephrine, 5011 ± 1888 pg/mL; norepinephrine, 8122 ± 2011 pg/mL) (p< .01), and they further increased until the 5th day (p< .01). ANP plasma levels were higher than normal in both groups at baseline (>300 pg/mL). ANP decreased in the CVVH patients on the 4th and 5th days (to 190 ± 45 pg/mL) (p< .02). ET-1 plasma concentrations increased only in the CVVH group (from 5.81 ± 1.07 to 14.8 ± .88 pg/mL) (p < .01). Changes of endocrinological regulators did not reveal any relationship to the measured hemodynamics. It is concluded that in patients undergoing pump-driven CVVH, plasma levels of important systemic and local vasoconstrictors significantly increased during CVVH. Disturbances in the balance of regulators of circulatory homeostasis may contribute to persisting organ failure and still high mortality in these patients.