To investigate the effect of renal replacement therapy (RRT) and sequential continuous diuretic infusion on patients with acute cardiorenal syndrome (CRS) in the perioperative period of cardiovascular surgery.

Medical records of 286 patients with acute CRS admitted to the ICU of Cardiology Center, Qingdao Municipal Hospital from November 2014 to December 2019 were retrospectively analyzed. Patients treated with RRT and sequential continuous diuretic infusion were included in the observation group (106 patients) and patients treated with continuous RRT were included in the control group (180 patients). The data were matched for the 1 ∶ 1 propensity score, and then 85 patients with better correlation were enrolled in both groups respectively. The general data, hospital mortality, ICU stay, postoperative hospital stay, hospital cost, creatinine at discharge, mean RRT time, chest reopening for hemostasis exploration, albumin, red blood cell input, gastrointestinal bleeding, lower extremity venous reflux disorder, maximum postoperative procalcitonin, left ventricular ejection fraction (LVEF) at discharge, pulmonary infection, mechanical ventilation time, arrhythmia during hospitalization and RRT-related complications were compared between the two groups.

There was no statistically significant difference in the hospital mortality between the observation group and control group [4.7% (4/85) vs. 5.9% (5/85), χ²=0.117, P=0.732]. The ICU stay [(10 ± 3) d vs. (13 ± 8) d, t=4.660, P=0.001], hospital cost [(18.2 ± 2.2) ten thousand yuan vs. (19.5 ± 3.9) ten thousand yuan, t=2.677, P=0.008], mean RRT time [(38 ± 9) h vs. (87 ± 21) h, t=19.922, P < 0.001], incidence of chest reopening for hemostasis exploration [1.2% (1/85) vs. 8.2% (7/85), χ²=4.722, P=0.030], albumin [(38 ± 11) g/L vs. (33 ± 10) g/L, t=3.043, P=0.003], red blood cell input [(631 ± 108) mL vs. (933 ± 229) mL, t=10.997, P < 0.001], LVEF at discharge [(43 ± 14)% vs. (38 ± 13)%, t=2.426, P=0.016] and incidence of pulmonary infection [10.6% (9/85) vs. 22.4% (19/85), χ²=4.276, P=0.039] were statistically significantly different between the observation group and control group. In the observation group, no one had RRT-related complications, gastrointestinal bleeding and lower extremity venous reflux disorder during the treatment; in the control group, six patients had RRT-related complications, four patients had gastrointestinal bleeding, and five patients had lower extremity venous reflux disorder.

RRT and sequential continuous diuretic infusion can promote the recovery of cardiac and renal functions in CRS patients and help reduce the incidence of RRT-related complications and serious adverse cardiovascular events.