Reduced hospitalizations in severe, refractory congestive heart failure with peritoneal dialysis: A consecutive case series

Rizkallah, Jacques; Sood, Manish M.; Reslerova, Martina; Córdova, Francisco; Malik, Amrit; Sathianathan, Chris; Estrella-Holder, E.; Zieroth, Shelley

doi:10.5414/cn108038

Cited by 19 publications

(36 citation statements)

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“…This may lead to the restoration of responsiveness to diuretics [43]. However, we did not find any significant differences in diuretic dose before and after PD [9,24,44,45,46]. …”

Section: Discussioncontrasting

confidence: 40%

“…Most recently, PD has been supported by several publications as another therapy for ultrafiltration in RCHF patients [7,8,9,10]. In 1951, the use of PD for RCHF was reported by Benhamou et al [11].…”

Section: Introductionmentioning

confidence: 84%

“…Where data were available, 5 studies used Tenckhoff catheters [8,16,17,18,19]. The dialysate utilized was dextrose (6 studies) [17,19,20,21,22,23], icodextrin (2 studies) [9,24], and dextrose or icodextrin (5 studies) [10,16,25,26,27]. The PD dose was not available for all studies.…”

Section: Resultsmentioning

confidence: 99%

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Peritoneal Dialysis in Patients with Refractory Congestive Heart Failure: A Systematic Review

Muciño-Bermejo

Ribeiro

et al. 2015

Cardiorenal Med

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Background: Refractory congestive heart failure (RCHF) is associated with a high mortality rate and is a major contributor to hospital admissions. Peritoneal dialysis (PD) is an option to control volume overload and perhaps improve outcomes in this challenging patient population. The aim of this systematic review is to describe the relative risk-benefit ratio based on data reported regarding the use of PD in RCHF. This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. An electronic search of PubMed, Embase, and the Cochrane Library was performed to identify relevant studies published from January 1951 to February 2014. Eligible studies selected were prospective or retrospective adult population studies on PD in the setting of RCHF. The following clinical outcomes were used to assess PD therapy: (1) hospitalization rates; (2) heart function; (3) renal function; (4) fluid overload, and (5) adverse clinical outcomes. Summary: Of 864 citations, we excluded 843 citations and included 21 studies (n = 673 patients). After PD, hospitalization days declined significantly (p = 0.0001), and heart function improved significantly (left ventricular ejection fraction: p = 0.0013; New York Heart Association classification: p = 0.0000). There were no statistically significant differences in glomerular filtration rate after PD treatment in non-chronic kidney disease stage 5D patients (p = 0.1065). Among patients treated with PD, body weight decreased significantly (p = 0.0006). The yearly average peritonitis rate was 14.5%, and the average yearly mortality was 20.3%. Key Messages: This systematic review suggests that PD may be an effective and safe therapeutic tool for patients with RCHF.

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“…This may lead to the restoration of responsiveness to diuretics [43]. However, we did not find any significant differences in diuretic dose before and after PD [9,24,44,45,46]. …”

Section: Discussioncontrasting

confidence: 40%

Section: Introductionmentioning

confidence: 84%

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Peritoneal Dialysis in Patients with Refractory Congestive Heart Failure: A Systematic Review

Muciño-Bermejo

Ribeiro

et al. 2015

Cardiorenal Med

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“…Theoretical advantages in favor of the use of PD rather than any form of intermittent or continuous hemodialysis are its gentle continuous ultrafiltration (avoiding neurohormonal pathway activation), being a permanent outlet from the abdominal cavity (thus keeping intra-abdominal pressure and venous congestion at their lowest), removing sodium efficiently, improving potassium levels (hence allowing [increased] use of renin-angiotensinaldosterone system blockers) and offering these benefits at home. Retrospective studies evaluating clinical effects of PD in patients with CRS2 showed significant reduction in number and duration of hospitalizations after initiation of PD, [54][55][56] improved functional New York Heart Association classification, 54,56,57 and improvement in left ventricular ejection fraction 54,55 at an acceptable cost of PD-related morbidity. [55][56][57] Continuous ambulatory PD (CAPD) was the main PD modality in these studies, all limited by the absence of a comparator group treated with an alternative renal replacement modality.…”

Section: Peritoneal Dialysis-related Peritonitismentioning

confidence: 99%

Evaluating the benefits of home-based peritoneal dialysis

François¹,

Bargman²

2014

IJNRD

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Peritoneal dialysis (PD) is an effective renal replacement strategy for patients suffering from end-stage renal disease. PD offers patient survival comparable to or better than in-center hemodialysis while preserving residual kidney function, empowering patient autonomy, and reducing financial burden to payors. The majority of patients suffering from kidney failure are eligible for PD. In patients with cardiorenal syndrome and uncontrolled fluid status, PD is of particular benefit, decreasing hospitalization rates and duration. This review discusses the benefits of chronic PD, performed by the patient or a caregiver at home. Recognition of the benefits of PD is a cornerstone in stimulating the use of this treatment strategy.

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“…Retrospective studies showed improved functional NYHA classification for patients with refractory congestive heart failure treated with peritoneal dialysis [41,47] . The prospective study by Cnossen et al evaluating the effect of renal replacement therapy, PD or HD, on functional status confirmed a significant improvement in the NYHA class, both at 4 and 8 months after the start of dialysis [45] .…”

Section: Outcomes On the Functional Statusmentioning

confidence: 99%

Peritoneal Dialysis for Chronic Congestive Heart Failure

2015

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Maladaptive responses between a failing heart and the kidneys ultimately lead to permanent chronic kidney disease, referred to as cardiorenal syndrome type 2. In this narrative review, we discuss the pathophysiological pathways in the progression of cardiorenal failure and review the current evidence on peritoneal dialysis as a treatment strategy in cardiorenal syndrome type 2. A patient with heart failure can present with clinical symptoms related to venous congestion even in the absence of end-stage renal disease. Diuretics remain the cornerstone for the treatment of fluid overload related to heart failure. However, with chronic use, diuretic resistance can supervene. When medical therapy is no longer able to relieve congestive symptoms, ultrafiltration might be needed. Patients with heart failure tolerate well the gentle rate of fluid removal through peritoneal dialysis. Recent publications suggest a positive impact of starting peritoneal dialysis in patients with cardiorenal syndrome type 2 on the hospitalisation rate, functional status and quality of life.

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Reduced hospitalizations in severe, refractory congestive heart failure with peritoneal dialysis: A consecutive case series

Cited by 19 publications

References 0 publications

Peritoneal Dialysis in Patients with Refractory Congestive Heart Failure: A Systematic Review

Peritoneal Dialysis in Patients with Refractory Congestive Heart Failure: A Systematic Review

Evaluating the benefits of home-based peritoneal dialysis

Peritoneal Dialysis for Chronic Congestive Heart Failure

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