Key result
Peritoneal dialysis is linked to improved NYHA stage and reduced heart size in refractory heart failure.
Why the study?
The effect of peritoneal dialysis on survival and heart failure severity in patients with progressive severe congestive heart failure resistant to drug therapy was unclear.
Observational (n=16)
Peritoneal dialysis may improve refractory HF symptoms; this small Level 3 cohort leaves open confirmation in randomized trials.
Our objective was to evaluate if peritoneal dialysis (PD) could improve survival of patients with progressive severe congestive heart failure resistant to drug therapy. The patients were selected by the cardiologist in cooperation with a nephrologist, including patients not responding to conventional medication with an expected fatal outcome within the next months. The study included 16 consecutive patients with a chronic progressive severe refractory heart failure (sHF) of NYHA class III (n = 6) or IV (n = 10) who did not respond to diuretics and angiotension converting enzyme (ACE) inhibitors. They had a mean age of 60 years (+/- 14, range 30-75, median 62 years). Nine of the patients had sHF as the only reason for initiating PD (all NYHA IV), while 7 also needed dialysis due to uremia. Five of 7 had been on hemodialysis but switched to PD due to a progressive congestive sHF. In 2 patients, PD was decided already at start of dialysis therapy due to the severity of their heart failure. The reason for sHF was: valvular dysfunction (n = 5) with defect prosthesis (n = 3); in the course of a myocardial infarction (n = 4); and cardiomyopathy (n = 4). Tenckhoff catheters were inserted under local anesthesia and ultrafiltration was started and maintained until discharge. The survival time and change in heart size by x-ray was used for analyses. All patients improved their stage of congestive heart failure by NYHA classification already during the first month. Six patients died during the follow-up period due to cardiac reasons (sudden death, relapse of sHF) after a mean of 10.7 months (+/- 3.7, range 1-24 months). Ten were alive after a median observation period of 10 months (+/- 12.5, range 1-36 months). Heart size was reduced in 15 of the patients. Three of the patients with sHF but without uremia could stop the PD. The results showed that ultrafiltration by PD was easy to perform despite low initial blood pressure. The sHF was reduced and life span was prolonged with improved quality of life.
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Stegmayr et al. (1996) conducted an observational in Severe refractory congestive heart failure (n=16). Peritoneal dialysis was evaluated on Survival time, change in heart size by x-ray, and NYHA classification change. Peritoneal dialysis improved NYHA heart failure stage in all 16 patients, reduced heart size in 15 patients, and resulted in 10 patients surviving after a median observation period of 10 months.
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