Successful weight reduction of over 70 kg under hemodialysis and renal function recovery after 87 days of anuria in a patient with dilated cardiomyopathy.

ABSTRACT

Cardiorenal syndrome is the term that describes the interaction between the heart and kidney that leads to diuretic resistance and worsening renal function. Prolonged anuria generally represents irreversible renal failure, and recovery of renal function after prolonged anuria in patients with heart failure has rarely been reported. Moreover, increased central venous pressure including heart failure is associated with impaired renal function. We herein report a rare case of a 46-year-old man with dilated cardiomyopathy who presented with dyspnea and generalized edema. His body weight increased from 90 kg to 128 kg in one year and he was hospitalized. Central venous pressure (CVP) on admission was 33 mmHg. Intravenous catecholamines were not effective; thus, he was started on continuous hemodiafiltration. Anuria occurred after hemodiafiltration due to heart failure, sepsis, and antibiotics use. However, he experienced weight reduction of over 70 kg, under hemodialysis guided by central venous pressure measurement, and renal function recovery after 87 days of anuria. His CVP had improved to 5 mmHg at discharge. This case showed continuous trial to reduce the CVP and raise cardiac output could result in the recovery of impaired renal function even in the presence of prolonged anuria. <Learning objective: We report a rare case of a patient with dilated cardiomyopathy who experienced weight reduction of over 70 kg under hemodialysis guided by central venous pressure (CVP) measurement and renal function recovery after 87 days of anuria due to chronic heart failure. Even in the presence of prolonged anuria, continuous trial to reduce the CVP and raise cardiac output could result in the recovery of impaired renal function.>.