AimsContinuous ambulatory peritoneal dialysis (CAPD) has been proposed as an additional therapeutic resource for patients with advanced congestive heart failure (CHF). The objective of this study was to determine the therapeutic role of CAPD, in terms of surrogate endpoints, in the management of patients with advanced CHF and renal dysfunction. Methods and resultsA total of 57 candidates with New York Heart Association (NYHA) class III/IV CHF, renal dysfunction (glomerular filtration rate , 60 mL/min/1.73 m 2 ), persistent fluid congestion despite loop diuretic treatment, and at least two previous hospitalizations for acute heart failure (AHF) were invited to be included in the CAPD programme; however, 25 patients were finally included. The primary outcome was evaluated by the change at 6 and 24 weeks for the Minnesota Living With Heart Failure Questionnaire (MLWHFQ), the 6 min walk test (6MWT), NYHA class, serum natriuretic peptides [brain natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP)], serum carbohydrate antigen 125 (CA125), and hospitalization rates for AHF. CAPD was associated with a substantial improvement in the MLWHFQ (-21.3, P , 0.001; and -20.4, P , 0.001), the 6MWT (54.0, P , 0.001; and 45.6, P ¼ 0.023), and NYHA class ( -1.0, P , 0.001; and -1.4, P , 0.001) at 6 and 24 weeks, respectively. The Ln(CA125) decreased markedly (-0.8, P ¼ 0.003; and -0.98, P ¼ 0.003), with no effect on BNP and NT-proBNP. There was a marked reduction in the number of days hospitalized for AHF (6 month post-CAPD vs. 6 months pre-CAPD: -84%; P , 0.001). ConclusionsIn advanced CHF and renal dysfunction, CAPD was associated with short/mid-term improvement in severity parameters, with an acceptable rate of side effects.--

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Objective: To study the influence of residual renal function (RRF) on different parameters of the renal substitutive treatment offered by peritoneal dialysis. Methods: We analyzed the impact of RRF on dialysis dose, nutrition parameters, anemia and phosphocalcic metabolism in 37 patients with end-stage renal disease (ESRD) treated by continuous ambulatory peritoneal dialysis (CAPD). Analytical controls were done every 6 months after an initial assessment at the end of the first month of treatment. Multiple lineal regression models were used as the statistical method to analyze the influence of RRF on different theoretically dependent factors. RRF was calculated as a mean of creatinine and urea clearances. Three observations per patient were used: one at the end of the first month of treatment; a final one at the end of follow-up (mean time 24.2 ± 11.4 months), and at a mean time between them (13.4 ± 6.7 months), with a final number of 111 observations. Results: Dialysis dose: RRF was the most important factor in terms of creatinine clearance (r² = 0.94; β = 0.999), KT/V (r² = 0.68; β = 0.819) and β₂-microglobulin levels (r² = 0.46; β = –0.489). Nutrition parameters: RRF was a determinant factor for normalized protein catabolic rate (r² = 0.53; β = 0.471), percent lean body mass (r² = 0.45; β = 0.446) and albumin levels (r² = 0.25; β = 0.229). Anemia: RRF was the most important factor when studying hemoglobin levels (r² = 0.28; β = 0.407). Phosphocalcic metabolism: Between the analyzed factors, RRF was the only one which reached significance on serum phosphate levels (r² = 0.19; β = –0.594). RRF did not show any relationship with either calcium or PTH levels. Conclusions: Independent of other factors, RRF in CAPD is positively and directly related to dialysis dose, β₂-microglobulin levels, nutrition parameters (albumin, normalized protein catabolic rate and percent lean body mass, hemoglobin and serum phosphate levels.

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