Efficacy of peritoneal ultrafiltration in the treatment of refractory congestive heart failure

Sánchez, José Emilio Hernández; Ortega, Teresa; Rodríguez, Concepción Fernández; Díaz‐Molina, Beatriz; Martı́n, Marı́a; García-Cueto, Carmen; Vidau, Pedro; Gago, E; Ortega, Francisco B.

doi:10.1093/ndt/gfp484

Cited by 106 publications

(156 citation statements)

References 14 publications

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“…To mitigate IDWG-related harm, non-HD day therapies, such as adjunct PD and wearable UF devices, may be beneficial. PD in patients with refractory heart failure has been shown to decrease hospitalizations and improve functional status (17). In a 13-patient study of 4-weeks duration, Jones et al (18) showed lower pre-HD BP and IDWG among patients treated with near daily UF (4 days of UF and 2 days of UF and HD).…”

Section: Discussionmentioning

confidence: 99%

Patient-Stated Preferences Regarding Volume-Related Risk Mitigation Strategies for Hemodialysis

Flythe

Mangione

Brunelli

et al. 2014

Clinical Journal of the American Society of Nephrology

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Background and objectives Larger weight gain and higher ultrafiltration rates have been associated with poorer outcomes among patients on dialysis. Dietary restrictions reduce fluid-related risk; however, adherence is challenging. Alternative fluid mitigation strategies include treatment time extension, more frequent dialysis, adjunct peritoneal dialysis, and wearable ultrafiltration devices. No data regarding patient preferences for fluid management exist. A survey was designed, tested, and administered to assess patient-stated preferences regarding fluid mitigation.Design, setting, participants, & measurements A written survey concerning fluid-related symptoms, patient and treatment characteristics, and fluid management preferences was developed. The cross-sectional survey was completed by 600 patients on hemodialysis at 18 geographically diverse ambulatory facilities. Comparisons of patient willingness to engage in volume mitigation strategies across fluid symptom burden, dietary restriction experience, and patient characteristics were performed.Results Final analyses included 588 surveys. Overall, if allowed to liberalize fluid intake, 44.6% of patients were willing to extend treatment time by 15 minutes. Willingness to extend treatment time was incrementally less for longer treatment extensions; 12.2% of patients were willing to add a fourth weekly treatment session, and 13.5% of patients were willing to participate in nocturnal dialysis three nights per week. Patients more bothered by their fluid restrictions (versus less bothered) were more willing to engage in fluid mitigation strategies. Demographic characteristics and symptoms, such as cramping and dyspnea, were not consistently associated with willingness to engage in the proposed strategies. More than 25% of patients were unsure of their dry weights and typical interdialytic weight gains.Conclusions Patients were generally averse to treatment time extension.15 minutes. Patients more bothered (versus less bothered) by their prescribed fluid restrictions were more willing to engage in volume mitigation strategies. Additional study of patient-stated preferences in hemodialysis treatment practices is needed to guide patient care and identify deficiencies in patient treatment and disease-related knowledge.

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Section: Discussionmentioning

confidence: 99%

Patient-Stated Preferences Regarding Volume-Related Risk Mitigation Strategies for Hemodialysis

Flythe

Mangione

Brunelli

et al. 2014

Clinical Journal of the American Society of Nephrology

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“…That reduction can be considered an indirect marker of improved quality of life in the patients and also a surrogate marker of better control of HF symptoms and signs. As a disease, HF is costly: 2% of the total health care budget in European countries is used for expenses related to its management (25). Rates of re-hospitalization for acute decompensated HF are as high as 20% in 6 months, and costs linked to hospitalizations represent two thirds of the total cost of the disease (2).…”

Section: Pd In Heart Failure Patients Refractory To Diureticsmentioning

confidence: 99%

Peritoneal Dialysis Reduces the Number of Hospitalization Days in Heart Failure Patients Refractory to Diuretics

et al. 2014

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♦ Background: Previous small studies have reported favorable results of peritoneal dialysis (PD) in the setting of chronic refractory heart failure (CRHF). We evaluated the impact of PD in a larger cohort of patients with CHRF where end-stage renal disease was excluded. ♦ Methods: All patients who received PD therapy for CRHF between January 1995 and December 2010 in two medical centers in France were included in this retrospective study. Baseline characteristics were compared with clinical parameters during the first year after initiation of PD. Mortality, safety, and sustainability of PD were also analyzed. ♦ Results: The 126 patients included had a mean age of 72 ± 11 years and an estimated glomerular filtration rate of 33.5 ± 15.1 mL/min/1.73 m2. Mean time on PD was 16 ± 16.6 months. During the first year, patients with a left ventricular ejection fraction (LVEF) of 30% or less experienced improvement in cardiac function (30% ± 10% vs 20% ± 6%, p < 0.0001). We observed a significant reduction in the number of days of hospitalization for acute decompensated heart failure after PD initiation (3.3 ± 2.6 days/patient-month vs 0.3 ± 0.5 days/patient-month, p < 0.0001). One-year mortality was 42%. ♦ Conclusions: In CRHF, PD significantly reduces the number of days of hospitalization for acute heart failure. Improved LVEF may have led to the comparatively good 1-year survival in this cohort.

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“…In many of the other studies that examined the effect of PUF on GFR, PUF was found to be ineffective on GFR (42,56,68,79). In a meta-analysis including six studies with a total of 282 patients without indications of renal replacement therapy, there was no significant difference in GFR before and after PUF (80).…”

Section: How Does Peritoneal Dialysis Affect Glomerular Filtration Rate?mentioning

confidence: 99%

“…One reason for the increase in EF is thought to be the removal of cardio depressant agents by PD (66). In many of these studies, the exercise capacities of HF patients were assessed by the NYHA classification and the results shows that NHYA class regresses and EF increases with PUF (58,(67)(68)(69)(70)(71)(72)(73).…”

Section: How Does Peritoneal Dialysis Affect Ejection Fraction or Newmentioning

confidence: 99%

“…Patient's preference as well as the clinical situation determines primarily the choice of UF for night or day and instrumental or manual methods. It has been shown that the rate of infection was lower with the use of single change instead of multiple changes (42,47,68,82). Especially in patients with residual renal function, the use of 'icodextrin', which provides long-term UF and allows single change, appears to be a more practical and appropriate option.…”

Section: Peritoneal Dialysis Catheter Placement Procedures and Peritonmentioning

confidence: 99%

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Role of Peritoneal Ultrafiltration in Heart Failure Treatment

Senel¹,

Cebeci²,

Öztürk³

2017

Haseki

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Efficacy of peritoneal ultrafiltration in the treatment of refractory congestive heart failure

Abstract: We demonstrate that congestive HF programmes should consider offering PD in hope of seeing better functional status, reduced morbidity and mortality, better quality of life as well as reduced health care costs.

Cited by 106 publications

References 14 publications

Patient-Stated Preferences Regarding Volume-Related Risk Mitigation Strategies for Hemodialysis

Patient-Stated Preferences Regarding Volume-Related Risk Mitigation Strategies for Hemodialysis

Peritoneal Dialysis Reduces the Number of Hospitalization Days in Heart Failure Patients Refractory to Diuretics

Role of Peritoneal Ultrafiltration in Heart Failure Treatment

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