Key result
Continuous ambulatory peritoneal dialysis increased sodium excretion, and higher total sodium removal was associated with a lower risk of death and worsening heart failure.
Why the study?
Long-term trajectories of sodium removal with continuous ambulatory peritoneal dialysis in refractory CHF and their prognostic associations were uncharacterized.
Does continuous ambulatory peritoneal dialysis increase total sodium removal and is it associated with reduced mortality and worsening heart failure in patients with refractory congestive heart failure?
Cohort (n=66)
No
Does continuous ambulatory peritoneal dialysis increase total sodium removal and is it associated with reduced mortality and worsening heart failure in patients with refractory congestive heart failure?
In patients with refractory congestive heart failure, continuous ambulatory peritoneal dialysis increases total sodium removal, which is associated with a lower risk of mortality and worsening heart failure.
Answers are grounded in this paper and cite their sources.
May guide decongestion assessment in refractory HF on CAPD; leaves open efficacy on outcomes pending prospective trials.
INTRODUCTION: Spot urinary sodium emerged as a useful parameter for assessing decongestion in patients with congestive heart failure (CHF). Growing evidence endorses the therapeutic role of continuous ambulatory peritoneal dialysis (CAPD) in patients with refractory CHF and kidney disease. We aimed to examine the long-term trajectory of urinary, peritoneal, and total (urinary plus peritoneal) sodium removal in a cohort of patients with refractory CHF enrolled in a CAPD program. Additionally, we explored whether sodium removal was associated with the risk of long-term mortality and episodes of worsening heart failure (WHF). METHODS: We included 66 ambulatory patients with refractory CHF enrolled in a CAPD program in a single teaching center. 24-h peritoneal, urinary, and total sodium elimination were analyzed at baseline and after CAPD initiation. Its trajectories over time were calculated using joint modeling of longitudinal and survival data. Within the framework of joint frailty models for recurrent and terminal events, we estimated its prognostic effect on recurrent episodes of WHF. RESULTS: At the time of enrollment, the mean age and estimated glomerular filtration rate were 72.8 ± 8.4 years and 28.5 ± 14.3 mL/min/1.73 m2, respectively. The median urinary sodium at baseline was 2.34 g/day (1.40-3.55). At a median (p25%-p75%) follow-up of 2.93 (1.93-3.72) years, we registered 0.28 deaths and 0.24 episodes of WHF per 1 person-year. Compared to baseline (urinary), CAPD led to increased sodium excretion (urinary plus dialyzed) since the first follow-up visit (p < 0.001). Over the follow-up, repeated measurements of total sodium removal were associated with a lower risk of death and episodes of WHF. CONCLUSIONS: CAPD increased sodium removal in patients with refractory CHF. Elevated sodium removal identified those patients with a lower risk of death and episodes of WHF.
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Miñana et al. (2023) conducted a cohort in Refractory congestive heart failure (n=66). Continuous ambulatory peritoneal dialysis (CAPD) and total sodium removal vs. Baseline (urinary sodium only) / lower sodium removal was evaluated on Sodium excretion and risk of death or worsening heart failure (p=<0.001). Continuous ambulatory peritoneal dialysis increased sodium excretion, and higher total sodium removal was associated with a lower risk of death and worsening heart failure.
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