Novel therapeutic option for refractory heart failure in elderly patients with chronic kidney disease by incremental peritoneal dialysis

Masaru Nakayama, Hirofumi Nakano, Masaaki Nakayama

Research output: Contribution to journalArticlepeer-review

49 Citations (Scopus)


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 ≤19 sessions of sequential hemofiltration, followed by incremental PD, with 3 PD sessions/week (8 h 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.

Original languageEnglish
Pages (from-to)49-54
Number of pages6
JournalJournal of cardiology
Issue number1
Publication statusPublished - 2010 Jan


  • Aging
  • Chronic kidney disease (CKD)
  • Heart failure
  • Peritoneal dialysis
  • Renal function

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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