PMID- 20122548
OWN - NLM
STAT- MEDLINE
DCOM- 20100826
LR  - 20220408
IS  - 0914-5087 (Print)
IS  - 0914-5087 (Linking)
VI  - 55
IP  - 1
DP  - 2010 Jan
TI  - Novel therapeutic option for refractory heart failure in elderly patients with 
      chronic kidney disease by incremental peritoneal dialysis.
PG  - 49-54
LID - 10.1016/j.jjcc.2009.08.003 [doi]
AB  - BACKGROUND: Heart failure (HF) often accompanies chronic kidney disease (CKD) in 
      the elderly. This clinical condition is a critical socio-medical issue, because 
      high-dose diuretic therapy stimulates the renin-angiotensin-aldosterone axis and 
      sympathetic nervous system outflow, and may thus result in vicious cycles of 
      cardio-renal deterioration, leading to excess hospitalization and death. 
      Peritoneal dialysis (PD) is a renal replacement therapy used for maintenance 
      dialysis, and is characterized by the continuous removal of fluid. The present 
      study examined the clinical feasibility and effects of a novel style of PD for 
      elderly CKD patients with refractory HF. METHODS: Twelve elderly CKD patients 
      (stages 3-5) with refractory HF [New York Heart Association (NYHA) class III, 
      n=9; IV, n=3; mean age, 81+/-6 years] received PD treatment. Patients had 
      episodes of >3 hospitalizations in the previous year, and were initially treated 
      with < or =19 sessions of sequential hemofiltration, followed by incremental PD, 
      with 3 PD sessions/week (8h each) at the start, increasing in frequency and 
      dwelling time as clinically indicated. RESULTS: During follow-up (median, 26.5 
      months), PD was well tolerated by all patients, and no patients required 
      hospitalization for HF. Three patients died due to non-HF-related events. All 
      patients showed improvements in NYHA functional class (class I, n=9; class II, 
      n=3) and significant decreases in the dose of diuretics prescribed (P<0.05). 
      Kidney function stabilized, while significant improvements in end-diastolic left 
      ventricular diameter (-5%, P<0.05) and hemoglobin count (+15%, P<0.05) were 
      achieved. Brain natriuretic peptide (-46%) and aldosterone (-13%) levels tended 
      to decrease. CONCLUSIONS: Incremental PD could represent a novel therapeutic 
      option for elderly patients with refractory HF. In addition to fluid removal by 
      PD, correction of renal anemia, preservation of kidney function, and avoidance of 
      high-dose diuretic therapy may play a role in maximizing clinical benefits.
CI  - 2009 Japanese College of Cardiology. Published by Elsevier Ltd. All rights 
      reserved.
FAU - Nakayama, Masaru
AU  - Nakayama M
AD  - Division of Cardiology, Kashima Hospital, 22-1 Kashimamachi, Shimokuramochi, 
      Aza-Nakasawame, Iwaki, Fukushima 971-8143, Japan. ms-nakayama@kashima.jp
FAU - Nakano, Hirofumi
AU  - Nakano H
FAU - Nakayama, Masaaki
AU  - Nakayama M
LA  - eng
PT  - Journal Article
DEP - 20090926
PL  - Netherlands
TA  - J Cardiol
JT  - Journal of cardiology
JID - 8804703
RN  - 0 (Diuretics)
RN  - 0 (Hemoglobins)
RN  - 114471-18-0 (Natriuretic Peptide, Brain)
RN  - 4964P6T9RB (Aldosterone)
RN  - 7LXU5N7ZO5 (Furosemide)
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Aldosterone/blood
MH  - Diuretics/administration & dosage
MH  - Female
MH  - Furosemide/administration & dosage
MH  - Heart Failure/*complications/*therapy
MH  - Hemofiltration
MH  - Hemoglobins/analysis
MH  - Humans
MH  - Kidney Failure, Chronic/*complications/*therapy
MH  - Male
MH  - Natriuretic Peptide, Brain/blood
MH  - Peritoneal Dialysis/*methods
EDAT- 2010/02/04 06:00
MHDA- 2010/08/27 06:00
CRDT- 2010/02/04 06:00
PHST- 2009/05/01 00:00 [received]
PHST- 2009/08/03 00:00 [revised]
PHST- 2009/08/07 00:00 [accepted]
PHST- 2010/02/04 06:00 [entrez]
PHST- 2010/02/04 06:00 [pubmed]
PHST- 2010/08/27 06:00 [medline]
AID - S0914-5087(09)00237-8 [pii]
AID - 10.1016/j.jjcc.2009.08.003 [doi]
PST - ppublish
SO  - J Cardiol. 2010 Jan;55(1):49-54. doi: 10.1016/j.jjcc.2009.08.003. Epub 2009 Sep 
      26.