Key result
Continuous ambulatory peritoneal dialysis improved MLWHFQ scores, walking distance test distance, functional class, and reduced AHF hospitalization days by 84%.
Why the study?
Continuous ambulatory peritoneal dialysis (CAPD) has been proposed as an additional therapeutic resource for patients with advanced congestive heart failure and renal dysfunction, but its therapeutic role needed evaluation.
Does continuous ambulatory peritoneal dialysis improve surrogate endpoints, symptoms, and hospitalization rates in patients with advanced congestive heart failure and renal dysfunction?
Cohort (n=25)
Does continuous ambulatory peritoneal dialysis improve surrogate endpoints, symptoms, and hospitalization rates in patients with advanced congestive heart failure and renal dysfunction?
Continuous ambulatory peritoneal dialysis may serve as an effective therapeutic alternative to improve symptoms, functional capacity, and reduce hospitalizations in patients with advanced heart failure and renal dysfunction.
Answers are grounded in this paper and cite their sources.
CAPD may ease symptoms and cut HF hospitalizations in advanced cases with renal dysfunction; leaves open need for RCTs before practice change.
AIMS: Continuous ambulatory peritoneal dialysis (CAPD) has been proposed as an additional therapeutic resource for patients with advanced congestive heart failure (CHF). The objective of this study was to determine the therapeutic role of CAPD, in terms of surrogate endpoints, in the management of patients with advanced CHF and renal dysfunction. METHODS AND RESULTS: A total of 57 candidates with New York Heart Association (NYHA) class III/IV CHF, renal dysfunction (glomerular filtration rate < 60 mL/min/1.73 m(2)), persistent fluid congestion despite loop diuretic treatment, and at least two previous hospitalizations for acute heart failure (AHF) were invited to be included in the CAPD programme; however, 25 patients were finally included. The primary outcome was evaluated by the change at 6 and 24 weeks for the Minnesota Living With Heart Failure Questionnaire (MLWHFQ), the 6 min walk test (6MWT), NYHA class, serum natriuretic peptides [brain natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP)], serum carbohydrate antigen 125 (CA125), and hospitalization rates for AHF. CAPD was associated with a substantial improvement in the MLWHFQ (-21.3, P < 0.001; and -20.4, P < 0.001), the 6MWT (54.0, P < 0.001; and 45.6, P = 0.023), and NYHA class (-1.0, P < 0.001; and -1.4, P < 0.001) at 6 and 24 weeks, respectively. The Ln(CA125) decreased markedly (-0.8, P = 0.003; and -0.98, P = 0.003), with no effect on BNP and NT-proBNP. There was a marked reduction in the number of days hospitalized for AHF (6 month post-CAPD vs. 6 months pre-CAPD: -84%; P < 0.001). CONCLUSIONS: In advanced CHF and renal dysfunction, CAPD was associated with short/mid-term improvement in severity parameters, with an acceptable rate of side effects.
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Núñez et al. (2012) conducted a cohort in Advanced congestive heart failure (CHF) and renal dysfunction (n=25). Continuous ambulatory peritoneal dialysis (CAPD) vs. Pre-CAPD baseline was evaluated on Change at 6 and 24 weeks for the Minnesota Living With Heart Failure Questionnaire (MLWHFQ), 6 min walk test (6MWT), NYHA class, serum natriuretic peptides, serum CA125, and hospitalization rates for AHF (p=<0.001). Continuous ambulatory peritoneal dialysis improved MLWHFQ scores, walking distance test distance, functional class, and reduced AHF hospitalization days by 84%.
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