Continuous ambulatory peritoneal dialysis as a therapeutic alternative in patients with advanced congestive heart failure

Abstract

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.--

Peritoneal ultrafiltration in end-stage congestive heart failure

“…Unfortunately, they are uncontrolled and the groups studied are small. Patients with coexisting renal failure may be treated with intermittent PD [21], continuous ambulatory PD [22][23][24][25][26] or automated PD [27][28][29][30], while in those without significant impairment of renal function -a single nightly exchange (PUF) with osmotic agent (optimally icodextrin) is sufficient [31][32][33][34][35]. In the vast majority of cases PD/PUF was performed in patients with advanced CHF and symptoms of cardiorenal syndrome as an addition to standard therapy.…”

“…The most important clinical studies on PD or an isolated PUF are presented in pt -patient; NA -data not available; PD -peritoneal dialysis Ewa Wojtaszek et al, Peritoneal ultrafiltration in end-stage congestive heart failure to diuretics, allowing for a significant (by as much as 50%) dose reduction and increased diuresis with stable renal function during the observation period [26,29,[32][33][34][35]. The effect of continuous, slow removal of water and sodium excess via peritoneal cavity may be of significance here, as it facilitates gradual reduction of extracellular volume and, subsequently, maintenance of normovolemia and neurohormonal stabilization.…”

“…Reduction or disappearance of clinical symptoms, accompanied by functional improvement in New York Heart Association (NYHA) class [22,23,25,28,30,31,33,34], with better exercise capacity [26] was observed in a great majority of patients. In some reports, this spectacular clinical improvement was accompanied by an increase in heart ejection fraction [25,28,31,34], or even -by a reduction in pulmonary artery pressure [24,26,34], which could be of great significance, giving some patients a chance to re-qualify for heart transplantation [22,23]. In such patients PUF could constitute a "bridge therapy" while awaiting heart transplantation, simultaneously reducing the risk of organ damage that could disqualify them from such a procedure.…”

“…In such patients PUF could constitute a "bridge therapy" while awaiting heart transplantation, simultaneously reducing the risk of organ damage that could disqualify them from such a procedure. The spectacular, 6-12-fold reduction in the frequency and duration of hospitalization, remains a fundamental advantage of PUF/PD [23,24,[26][27][28][30][31][32][33][34]. This effect is particularly significant in patients who use it as palliative therapy with regard to their quality of life as well as healthcare costs [26,34].…”

“…The spectacular, 6-12-fold reduction in the frequency and duration of hospitalization, remains a fundamental advantage of PUF/PD [23,24,[26][27][28][30][31][32][33][34]. This effect is particularly significant in patients who use it as palliative therapy with regard to their quality of life as well as healthcare costs [26,34]. Pharmacoeconomic analysis conducted by authors from Spain revealed a nearly 4-fold reduction in yearly costs with application of PUF in comparison to standard therapy [34].…”