PMID- 16024831
OWN - NLM
STAT- MEDLINE
DCOM- 20080423
LR  - 20220408
IS  - 1460-2385 (Electronic)
IS  - 0931-0509 (Linking)
VI  - 20 Suppl 7
DP  - 2005 Jul
TI  - Peritoneal dialysis in refractory end-stage congestive heart failure: a challenge 
      facing a no-win situation.
PG  - vii32-6
AB  - BACKGROUND: Current medical therapeutic strategies for refractory congestive 
      heart failure (CHF) in the population of 65 years and older with 
      contraindications for heart transplantation are limited. Peritoneal dialysis 
      applied to CHF patients with or without renal impairment showed clinical 
      functional improvement. METHODS: A single centre, prospective but non-randomized 
      study in 20 patients with severe congestive heart failure refractory to optimal 
      pharmacological therapy [New York Heart Association (NYHA), class IV] was 
      performed between 2000 and 2003. The mean age was 65.71+/-7.66 years. The 
      patients had a baseline glomerular filtration rate of 14.84+/-3.8 ml/min. Fifteen 
      patients were diabetics (type I, 10; type II, five). For all patients, the 
      baseline ejection fraction was <35% (31.2+/-4.7%). The mean Charlson's 
      co-morbidity index was 7.8+/-1.8. Patients were treated initially by 2-5 sessions 
      of continuous veno-venous haemofiltration (CVVH) or sequential haemofiltration 
      (SHF). Automated peritoneal dialysis (APD) was started after implantation of a 
      Tenckhoff catheter. Three APD sessions/week (8 h each), with 15-20 l of dialysis 
      fluid (PDF) per session (10.35+/-3.05 l of 1.5% lactated glucose and 8.95 +/-2.95 
      l of 4.25% glucose PDF), were performed. Total follow-up ranged between 7 and 35 
      months (mean 19.80+/-7.37). RESULTS: After 1 year of follow-up, all patients 
      showed haemodynamic improvement: significant improvement of left cardiac work 
      index (2.33+/-0.69 to 2.59+/-0.47 kg min/m(2)), reduction of the systolic times 
      ratio (61.14+/-12.57 to 39.18+/-13.44%), lower thoracic fluid contents 
      (0.04+/-0.005 to 0.003+/-0.0001 Omega) as well as a regression from NYHA class IV 
      to class I. Need for hospitalization for CHF decreased from 157 to 13 days. 
      CONCLUSIONS: Peritoneal dialysis appears to be a promising therapeutic tool for 
      patients affected by refractory CHF. Clinical improvement of cardiac function may 
      be related to clearing blood from middle molecular weight myocardial depressant 
      substances, including atrial natriuretic peptide. Prospective multicentre trials 
      are needed to confirm these encouraging results.
FAU - Gotloib, Lazaro
AU  - Gotloib L
AD  - Center for Experimental Nephrology, Ha'Emek Medical Center, Afula 18101, Israel. 
      gotloib@012.net.il
FAU - Fudin, Roberto
AU  - Fudin R
FAU - Yakubovich, Michaela
AU  - Yakubovich M
FAU - Vienken, Joerg
AU  - Vienken J
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - England
TA  - Nephrol Dial Transplant
JT  - Nephrology, dialysis, transplantation : official publication of the European 
      Dialysis and Transplant Association - European Renal Association
JID - 8706402
SB  - IM
CIN - Nephrol Dial Transplant. 2005 Jul;20 Suppl 7:vii37-40. PMID: 16024832
MH  - Aged
MH  - Blood Pressure/physiology
MH  - Follow-Up Studies
MH  - Glomerular Filtration Rate/physiology
MH  - Heart Failure/physiopathology/*therapy
MH  - Humans
MH  - Kidney Diseases/therapy
MH  - Middle Aged
MH  - *Peritoneal Dialysis
MH  - Prospective Studies
MH  - Stroke Volume/physiology
MH  - Water-Electrolyte Balance/physiology
EDAT- 2005/07/19 09:00
MHDA- 2008/04/24 09:00
CRDT- 2005/07/19 09:00
PHST- 2005/07/19 09:00 [pubmed]
PHST- 2008/04/24 09:00 [medline]
PHST- 2005/07/19 09:00 [entrez]
AID - 20/suppl_7/vii32 [pii]
AID - 10.1093/ndt/gfh1105 [doi]
PST - ppublish
SO  - Nephrol Dial Transplant. 2005 Jul;20 Suppl 7:vii32-6. doi: 10.1093/ndt/gfh1105.