TY - JOUR
T1 - Novel therapeutic option for refractory heart failure in elderly patients with chronic kidney disease by incremental peritoneal dialysis
AU - Nakayama, Masaru
AU - Nakano, Hirofumi
AU - Nakayama, Masaaki
N1 - Copyright:
Copyright 2010 Elsevier B.V., All rights reserved.
PY - 2010/1
Y1 - 2010/1
N2 - 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.
AB - 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.
KW - Aging
KW - Chronic kidney disease (CKD)
KW - Heart failure
KW - Peritoneal dialysis
KW - Renal function
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U2 - 10.1016/j.jjcc.2009.08.003
DO - 10.1016/j.jjcc.2009.08.003
M3 - Article
C2 - 20122548
AN - SCOPUS:72449212204
VL - 55
SP - 49
EP - 54
JO - Journal of Cardiology
JF - Journal of Cardiology
SN - 0914-5087
IS - 1
ER -