Peritoneal dialysis as a therapeutic solution in elderly patients with cardiorenal syndrome and heart failure: A case-series report

摘要

The aim of this work was to evaluate the impact of peritoneal dialysis (PD) on venous congestion, right ventricle function, pulmonary artery systolic pressure (PASP) and clinical functional status in elderly patients with cardiorenal syndrome (CRS) and chronic heart failure (HF). A case series of 21 (17 males, age 70±11 years) consecutive patients with diuretic-resistance HF and right ventricular dysfunction (median renal failure duration 60 months, range 13-287 months, mean ejection fraction 36±11%) having been engaged in PD; 76% of the patients were under Automated Peritoneal Dialysis (APD), whereas the rest were under Continuous Ambulatory PD (CAPD). Patients' PASP and central venous pressure (CVP) - through compression sonography - and body weight were evaluated before initiating PD program, at 6 months and at 12 months. During the follow-up period, the mortality rate was 8 deaths out of 21 patients (38%) A significant reduction by 29.9% in PASP levels (p=0.013) and by 42% in CVP levels (p0.001), and in right ventricular function assessed by tricuspid annulus tissue doppler velocity (p= 0.04) was observed; whereas patients weight increased by 3.7% (p=0.001). New York Heart Association class improved in 12 patients; whereas, in the rest patients remained constant (p=0.046). In 8 patients complications were reported (mainly presence of staphylococcus. aureus). In conclusion, PD seems to confer a substantial benefit in clinical status, in line with improvement in venous congestion and right ventricle systolic pressure among elderly HF patients with CRS. Copyright ? 2019 Hellenic Society of Cardiology. Published by Elsevier B.V. All rights reserved.