Isolation of "myocardial depressant factor(s)" from the ultrafiltrate of heart failure patients with acute renal failure

ASAIO J. Sep-Oct 1996;42(5):M911-5. doi: 10.1097/00002480-199609000-00127.


Cardiac function improvement seen with hemofiltration may be attributable to "cardiac depressant factor(s)" removal. The authors have attempted "factor" isolation. Initial 12 hr hemofiltrate was obtained from: 4 patients with acute congestive heart failure (cardiac index: 2.02 +/- 0.48) and acute renal failure (blood urea nitrogen [BUN] 97.7 +/- 32.7; serum creatinine [SCr] 6.2 +/- 3.4 mg%) (Group I); 8 patients with chronic congestive heart failure (CI: 2.69 +/- 1.3) and mild renal failure (BUN 48.8 +/- 31.4; SCr 3.5 +/- 2.4 mg%) (Group II); and 8 patients with end-stage renal disease and no congestive heart failure (Group III). Crude samples were passed through C18Sep-Pak, and eluted with methanol/water mixtures, and 50% methanol samples were fractionated by high pressure liquid chromatography. Inotropic response was studied by injecting samples (in Krebs-Hensleit buffer) into a Langendorff rat heart preparation. The effect of pH, acetate, salts, and adding propranolol on the inotropic response also was tested. Myocardial depression followed all vehicle and preparatory elements: 0.1 M HCl (-47%); 0.08 M acetic acid (-75%); Na acetate (-25%); 0.1 M NaHCO3 (-11%); Na citrate (-84%); and Na glutarate (-14%). Group I had biphasic responses, the positive inotropism accorded to catecholamines, whereas negative inotropism was equal in each patient (-40.3%). Group II had a biphasic response with negative (-15%) inotropism noted. Group III was weakly biphasic. The data indicate there was myocardial depressive activity, most pronounced in Groups I and II, after method interference was corrected.

MeSH terms

  • Acute Kidney Injury / blood*
  • Acute Kidney Injury / complications
  • Acute Kidney Injury / therapy*
  • Animals
  • Chromatography, High Pressure Liquid
  • Heart / drug effects
  • Heart Failure / blood*
  • Heart Failure / complications
  • Heart Failure / therapy*
  • Hemofiltration* / methods
  • Humans
  • In Vitro Techniques
  • Kidney Failure, Chronic / blood
  • Kidney Failure, Chronic / therapy
  • Myocardial Contraction / drug effects
  • Myocardial Depressant Factor / isolation & purification*
  • Myocardial Depressant Factor / pharmacology
  • Rats


  • Myocardial Depressant Factor