On November 28, the patient made a good recovery and was successfully discharged to go home.
The patient (center) took a commemorative photo with the medical staff upon discharge after recovery.
Pulmonary Hypertension Leads to Cardiorenal Syndrome
Ten years ago, Mr. Xiao, then only 34 years old, was diagnosed with "idiopathic pulmonary hypertension" and had been undergoing medication treatment. In 2022, Mr. Xiao experienced chest tightness accompanied by ascites and elevated creatinine levels, eventually being diagnosed with "chronic renal failure." Since then, Mr. Xiao became a frequent patient at the hospital, continuously receiving kidney protection and heart failure treatment.
At the end of October this year, Mr. Xiao once again experienced chest tightness, shortness of breath, inability to lie flat, and oliguria. To alleviate his symptoms, Mr. Xiaos family took him to the nephrology department of Hainan Chengmei Hospital for treatment.
Dr. Lin Rongyu, Associate Chief Physician of Nephrology at Hainan Chengmei Hospital, explained that Mr. Xiaos condition was critical. He was diagnosed with Type II cardiorenal syndrome, chronic renal failure (acute exacerbation), pulmonary heart disease, metabolic acidosis, acute right heart failure, and 12 other conditions. He urgently required renal replacement therapy. The most challenging issue was that Mr. Xiaos blood pressure was only 76/45 mmHg, with the risk of shock and coma due to extremely low blood pressure. He needed continuous use of vasopressors to maintain his blood pressure and could not tolerate regular hemodialysis treatment.
After understanding Mr. Xiaos urgent situation, Professor Chen Wen, the Director of Nephrology, immediately initiated an interdisciplinary consultation. After a comprehensive risk assessment, they decided to perform bedside peritoneal dialysis catheterization for emergency peritoneal dialysis to avoid irreversible accidents during patient transport.
(Emergency Bedside Surgery Scenario)
After thorough communication with the family, on November 4, the medical staff prepared the room in advance, disinfected, and gathered the necessary items. Under the guidance of Professor Chen Wen, two associate chief physicians, Lin Rongyu and Wu Qixian, cooperated to perform bedside peritoneal dialysis catheterization for the patient.
Lin Rongyu explained that the surgical process was extremely risky at the time. The patients shortness of breath and inability to lie flat added difficulty to the procedure. Additionally, the patients poor heart function meant that any slight mistake could trigger acute heart failure. Fortunately, there were no major complications, and the surgery proceeded smoothly. The trial drainage during surgery was unobstructed, and after the routine peritoneal dialysis, the patients condition stabilized.
After the treatment, Mr. Xiaos symptoms, such as chest tightness and shortness of breath, significantly improved.
Cardiorenal Syndrome Requires Individualized Treatment Plans
Professor Chen Wen introduced that cardiorenal syndrome refers to the acute or chronic dysfunction of one organ (heart or kidney) leading to the dysfunction of the other organ, or the simultaneous damage to both organs caused by a systemic disease. Mr. Xiao developed cardiorenal syndrome due to idiopathic pulmonary hypertension, which led to a series of pathological changes in the heart and kidney systems.
Expert Reminder
The treatment of cardiorenal syndrome is not an isolated process. It requires multidisciplinary cooperation, a deep understanding of the patients clinical factors, finding a balance point in each patient, and addressing both heart and kidney diseases with individualized and comprehensive treatment measures.
Professor Chen Wen stated that with the widespread use of continuous renal replacement therapy (CRRT) machines in the rescue of critically ill patients, when patients present with bleeding tendencies, hypovolemic shock, severe cardiorenal syndrome, or other conditions, bedside catheterization for peritoneal dialysis offers significant advantages: short surgery time, minimal trauma, and no need to move the patient. This approach maximizes the time available for rescuing patients, especially those with severe cardiorenal syndrome.
The success of bedside peritoneal dialysis catheterization marks the hospitals achievement of reaching an advanced level in the treatment of severe cardiorenal syndrome compared to domestic peers.
Expert Introduction
(Consultation Hours)
General Consultation: Every Monday, Wednesday, and Thursday morning
Specialist Consultation: Every Friday morning
Text by: Huang Fei