Outcomes after Acute Peritoneal Dialysis for Critical Cardiorenal Syndrome Type 1

Abstract

<b><i>Introduction:</i></b> The aim of the study was to demonstrate the outcomes of peritoneal dialysis (PD) in critically ill cardiorenal syndrome type 1 (CRS1). <b><i>Methods:</i></b> A cohort of 147 patients with CRS1 who received PD from 2011 to 2019 in a referral hospital in Thailand was analyzed. The primary outcome was 30-day in-hospital mortality. Ultrafiltration and net fluid balance among survivors and nonsurvivors in the first 5 PD sessions were compared. <b><i>Results:</i></b> The 30-day mortality rate was 73.4%. Most patients were critically ill CRS1 (all patients had a respiratory failure of which 68% had cardiogenic shock). Blood urea nitrogen and creatinine at the commencement of PD were 60.1 and 4.05 mg/dL. In multivariable analysis, increasing age, unstable hemodynamics, and positive fluid balance in the first 5 PD sessions were associated with the risk of in-hospital mortality. The change of fluid balance per day during the first 5 dialysis days was significantly different among survivor and nonsurvivor groups (−353 vs. 175 mL per day, <i>p</i> = 0.01). <b><i>Conclusions:</i></b> PD is a viable dialysis option in CRS1, especially in a resource-limited setting. PD can save up to 27% of lives among patients with critically ill CRS1.

Risk Factors and Outcome Variables of Cardiorenal Syndrome Type 1 in Acute Myocardial Infarction Patients

“…Increased age, unstable hemodynamics, and positive total fluid balance over the first 5 days of peritoneal dialysis were factors for an increased risk of death. 17 …”

“…Increased age, unstable hemodynamics, and positive total fluid balance over the first 5 days of peritoneal dialysis were factors for an increased risk of death. 17 APACHE II, 18 SOFA, 19 and SAPS II 20 scores are the most widely used scores in the clinic to assess a patient's prognosis. In our study, the three scores at 48 hours had no value in predicting death.…”

Cardiorenal Syndrome: Challenges in Everyday Clinical Practice and Key Points towards a Better Management

“…PD has several advantages over extracorporeal dialysis as it requires less infrastructure and specialized staff, causes less hemodynamic disturbances, is associated with a lower risk of bleeding, and has showed more benefit for fluid control and the preservation of renal function compared to UF therapy [ 85 , 86 ]. According to a study from Thailand which included 147 patients with CRS1 during acute coronary syndrome (ACS), those who received PD as a primary treatment achieved better hemodynamic stability and survival [ 87 ]. Moreover, the hemodynamic impact of PD on venous congestion, right ventricular function, pulmonary artery systolic pressure (PASP), and clinical status was studied in 21 elderly patients with CRS and CHF.…”