Nursing care for patients with cardiorenal syndrome after heart transplantation undergoing continuous renal replacement therapy: A case report and literature review

Abstract

Rationale: Heart transplantation (HT) represents the optimal treatment for patients with end-stage heart disease. However, it is prone to numerous postoperative complications, among which cardio-renal syndrome (CRS) is particularly serious and carries a high mortality rate. Continuous renal replacement therapy is an essential supportive treatment for these patients, but its efficacy is highly dependent on precise nursing management. Currently, there are few reports on the care of CRS complicating HT both domestically and internationally. This case is presented in this report to provide reference for clinical work.

Patient concerns: This report details the case of a 31-year-old man who underwent an in situ HT due to dilated cardiomyopathy with class IV cardiac function. Following the operation, he developed CRS, which led to oliguria, rapid deterioration of renal function, and cardiac failure.

Diagnoses: Cardiorenal syndrome, chronic kidney disease stage 4, post-dilated cardiomyopathy surgery, HT status, heart function class IV (NYHA classification).

Interventions: This includes implementing a personalized continuous renal replacement therapy (CRRT) program and providing excellent CRRT care; closely monitoring for rejection and the side effects of immunosuppressants; and offering comprehensive psychological support.

Outcomes: After undergoing CRRT for 5 weeks, the patient's 24-hour urine volume, glomerular filtration rate, and N-terminal brain natriuretic peptide precursor levels stabilized, leading to discharge with improved renal function.

Lessons: The key to a favorable renal function prognosis is the use of CRRT for precise volume management. Careful management of internal jugular vein catheterization is crucial for preventing infections in post-heart transplant patients. Additionally, monitoring the side effects of immunosuppressive drugs and signs of rejection are essential nursing points for patients with cardiorenal syndrome. Providing psychological care in various forms to patients and their families can help improve disease outcomes and ensure long-term efficacy after transplantation.

Keywords: continuous renal replacement therapy; heart transplantation; personalized care.