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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 27, No 3, May/June 2016
130
AFRICA
to compare 30-day patient survival between the two groups. A
p
-value
<
0.05 was considered statistically significant.
Results
The clinical features of the patients are summarised in Table
1. According to KDIGO criteria, 36 (41.86%) patients were
diagnosed with AKI on the third day of iloprost infusion therapy.
Co-morbidities and drug use (ASA, clopidogrel, LMWH, statin,
ACEI) rates were similar in those with and without AKI (Table 1).
When the entire study group was analysed, serum creatinine
levels recorded on the third and 28th day of treatment (1.53
±
0.12 and 1.46
±
0.1 mg/dl, respectively) (135.25
±
10.61 and
129.06
±
8.84 μmol/l) were significantly higher than the baseline
level [1.15
±
0.6 mg/dl (101.66
±
53.04 μmol/l),
p
=
0.001 for
both]. The BUN level recorded on the third day (30.0
±
20.7 mg/
dl) was significantly higher than the baseline level (23.6
±
13.7
mg/dl,
p
=
0.014), as was the serum C-reactive protein (CRP)
level (81.12
±
4.67 vs 52.48
±
4.85 mg/dl,
p
=
0.009). On the third
day of the infusion, urinary output was significantly increased
from the baseline value (1 813.30
±
1 123.46 vs 1 545.17
±
873.0
cm
3
,
p
=
0.012) while eGFR values were significantly lower
compared to baseline levels (71.16
±
43.43 vs 76.98
±
35.57 ml/
min/1.73 m
2
,
p
=
0.01) (Table 2). All patients had a significant
decrease from baseline in diastolic blood pressure on the third
day of infusion therapy (70.29
±
14.94 vs 74.37
±
9.09 mmHg,
p
=
0.011). Patients’ mean arterial pressures were significantly
decreased on the third day of therapy (90.57
±
10.5 vs 86.25
±
17.9 mmHg,
p
=
0.024).
On the 28th day, eGFR values were significantly lower than
baseline values (72.84
±
53.39 vs 76.98
±
35.57 ml/min/1.73 m
2
,
p
=
0.01) (Table 2). All patients had a significant decrease in
diastolic blood pressure on the 28th day compared to baseline
values (71.20
±
12.65 vs 74.37
±
9.09 mmHg,
p
=
0.025). A
non-significant trend towards a lower blood pressure on the third
and 28th days was observed (
p
>
0.05) (Table 2). According to
data from the 28th day, renal function improved as BUN levels
decreased to baseline values, while the creatinine level was high
and eGFR was significantly lower (Table 2).
Patients who developed AKI had significantly higher
serum creatinine (
p
=
0.032) and CRP (
p
=
0.012) levels and
significantly lower eGFR values (
p
=
0.05) at baseline compared
to patients without AKI (Table 3). Those who developed AKI
had significantly higher serum BUN (
p
=
0.001) and creatinine
(
p
=
0.001) levels and lower eGFR (
p
=
0.001) and systolic (
p
=
0.015), diastolic (
p
=
0.014) and mean arterial (
p
=
0.039) blood
pressure values on the third day of infusion compared to patients
without AKI (Table 3).
Serum glucose levels of patients with AKI were significantly
higher both compared to their own baseline value (
p
=
0.042) and
to the value of the third day of patients without AKI (
p
=
0.037)
(Table 3). Patients who developed AKI had significantly higher
serum creatinine (
p
=
0.001), BUN (
p
=
0.012), CRP (
p
=
0.001)
and urinary output (
p
=
0.005) levels on the third day of infusion
Table 3. Laboratory parameters of the whole group
Laboratory
parameters
Initial
Third day of infusion
Two weeks after infusion
p-
values
within
the AKI
group
Patients with
AKI (
n
=
36)
Patients without
AKI (
n
=
50)
p
-value
Patients with
AKI (
n
=
36)
Patients without
AKI (
n
=
50)
p-
value
Patients with
AKI (
n
=
36)
Patients without
AKI (
n
=
50)
p-
value
Glucose (mg/dl)
(mmol/l)
146.32
±
67.9
(8.12
±
3.77)
141.21
±
72.3
(7.84
±
4.01)
>
0.05 120.46
±
41.7
(6.69
±
2.31)
146.20
±
47.3
(8.11
±
2.63)
0.037 133.17
±
61.3
(7.39
±
3.40)
147.10
±
72.0
(8.16
±
4.00)
>
0.05 0.042
*
>
0.05
§†
BUN (mg/dl)
26.0
±
12.1
22.4
±
14.7
>
0.05 44.88
±
21.6
19.40
±
8.28
0.001 33.08
±
15.5
18.4
±
9.1
0.001 0.012
*
0.001
§†
Creatinine (mg/dl)
(μmol/l)
1.28
±
0.60
(113.15
±
53.04)
1.05
±
0.5
(92.82
±
44.20)
0.032 2.37
±
1.26
(209.51
±
111.38)
0.94
±
0.3
(83.10
±
26.52)
0.001 2.14
±
1.11
(189.18
±
98.12)
0.87
±
0.3
(76.91
±
26.52)
0.001 0.001
*
>
0.05
§
0.001
†
Haemoglobin (g/dl)
12.09
±
2.1
13.04
±
2.0
>
0.05 11.33
±
1.8
12.06
±
1.8
>
0.05 11.88
±
1.1
12.30
±
1.6
>
0.05
>
0.05
*§†
Sodium (mmol/l)
136.91
±
4.0
133.74
±
19.1
>
0.05 138.05
±
6.2
136.91
±
3.4
>
0.05 139.16
±
5.6
135.20
±
20.3
>
0.05
>
0.05
*§†
Potassium (mmol/l)
4.34
±
0.5
4.19
±
0.9
>
0.05 4.17
±
0.6
4.07
±
0.7
>
0.05
4.16
±
0.8
4.17
±
0.2
>
0.05
>
0.05
*§†
Phosphorus
(mg/dl)
3.72
±
0.8
3.22
±
0.6
>
0.05 4.28
±
2.9
3.28
±
0.5
>
0.05
4.60
±
1.6
3.23
±
0.7
>
0.05
>
0.05
*§†
Calcium (mg/dl)
8.84
±
0.5
8.93
±
0.7
>
0.05 8.98
±
1.09
8.67
±
0.6
>
0.05
9.21
±
1.9
8.78
±
0.7
>
0.05
>
0.05
*§†
Albumin (g/dl)
3.53
±
0.6
3.73
±
0.8
>
0.05 2.62
±
1.0
3.42
±
0.6
>
0.05
2.91
±
0.7
3.62
±
0.6
0.001
>
0.05
*§†
CRP (mg/dl)
67.62
±
7.7
40.38
±
4.3
0.012 102.85
±
9.7
70.67
±
6.6
0.012 90.62
±
8.7
52.80
±
9.3
>
0.05 0.001
*
>
0.05
§
0.01
†
Urinary output
(cm
3
/24 h)
1242.91
±
990.15 1663.37
±
736.3
>
0.05 1503.20
±
1267.09 1918.18
±
827.1
0.004 1259.63
±
986.0 1632.96
±
648.2
>
0.05 0.005
*§
>
0.05
†
eGFR (MDRD)
70.22
±
41.7
84.83
±
34.3
0.05 36.04
±
23.4
93.10
±
40.2
0.001 40.68
±
25.9 101.03
±
52.84 0.001 0.0001
*†
>
0.05
§
Systolic blood pres-
sure (mmHg)
121.6
±
19.5 123.78
±
14.5
>
0.05 106.8
±
31.7
125.0
±
10.8
0.015 116.2
±
28.6 124.92
±
20.1
>
0.05 0.002
*
>
0.05
§
0.023
†
Diastolic blood
pressure (mmHg)
71.8
±
10.5
75.90
±
7.8
>
0.05 61.2
±
17.5
74.64
±
8.2
0.014 65.4
±
16.4
75.71
±
9.9
0.001 0.023
*
>
0.05
§
0.002
†
Mean arterial pres-
sure (mmHg)
88.40
±
12.5
91.86
±
8.9
>
0.05 76.0
±
21.6
91.42
±
8.0
0.039 82.36
±
19.9
92.11
±
12.1 0.002 0.003
*
>
0.05
§
0.04
†
*
p
-value for initial vs on the third day of infusion;
§
p
-value for initial vs two weeks after infusion;
†
p
-value for third day vs two weeks after infusion.
BUN, blood urea nitrogen; CRP, C-reactive protein; eGFR, estimated glomerular filtration rate.