Intermittent Outpatient Ultrafiltration for Severe Refractory Congestive Heart Failure

Sheppard, Richard; Panyon, Jessica; Pohwani, Amar; Johnston, James R.; MacGowan, Guy A.; Mathier, Michael A.; McNamara, Dennis M.; Murali, Srinivas

doi:10.1016/s1071-9164(03)00265-3

Cited by 3 publications

(18 citation statements)

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“…24,31,37,38,49,52 For outpatient studies with follow-up period ≥ 1 year, the overall mortality was 48.3%. 27,28,35,43 –51,54 The high mortality rate was not unexpected in patients with symptomatic HF.…”

Section: Resultsmentioning

confidence: 97%

“…In all, 31 articles (902 patients) were identified for inclusion in this review. 24 –28,31 –56 The flow diagram depicting the selection process is illustrated in Figure 1(a).…”

Section: Resultsmentioning

confidence: 99%

“…31 Twenty-two studies reported the NYHA status of patients on enrolment and all of these included only patients with NYHA class III or IV symptoms. 25 –27,31,33,35 –37,39,41 –45,47 –51,53 –55 Only one study had patients in NYHA class II (3 of 48 patients). 36 Nineteen studies measured the LVEF of the patients prior to starting PD or EC therapy and the mean LVEF ranged from < 20% 37 to 56% 47…”

Section: Resultsmentioning

confidence: 99%

“…Table 3 also lists the parameters of the EC techniques (HD or UF) employed in four studies. This ranged from conventional HD 57 to UF 42,50 or a combination of both. 32…”

Section: Resultsmentioning

confidence: 99%

“…Of the four studies which included patients assigned to PD or EC interventions, 32,39,42,50 only three reported mortality data separately for each arm 32,39,50 (Table 4). These three studies were from different geographical areas – Japan, the Netherlands and the United States.…”

Section: Resultsmentioning

confidence: 99%

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The use of peritoneal dialysis in heart failure: A systematic review

Chionh

Clementi²,

Poh

et al. 2020

Perit Dial Int

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Heart failure (HF) is a major cause of morbidity and mortality. Extracorporeal (EC) therapy, including ultrafiltration (UF) and haemodialysis (HD), peritoneal dialysis (PD) and peritoneal ultrafiltration (PUF) are potential therapeutic options in diuretic-resistant states. This systematic review assessed outcomes of PD and compared the effects of PD to EC. A comprehensive search of major databases from 1966 to 2017 for studies utilising PD (or PUF) in diuretic-resistant HF was conducted, excluding studies involving patients with end-stage kidney disease. Data were extracted and combined using a random-effects model, expressed as odds ratio (OR). Thirty-one studies ( n = 902) were identified from 3195 citations. None were randomised trials. Survival was variable (0–100%) with a wide follow-up duration (36 h–10 years). With follow-up > 1 year, the overall mortality was 48.3%. Only four studies compared PD with EC. Survival was 42.1% with PD and 45.0% with EC; the pooled effect did not favour either (OR 0.80; 95% confidence interval (CI): 0.24–2.69; p = 0.710). Studies on PD in patients with HF reported several benefits. Left ventricular ejection fraction (LVEF) improved after PD (OR 3.76, 95%CI: 2.24–5.27; p < 0.001). Seven of nine studies saw LVEF increase by > 10%. Twenty-one studies reported the New York Heart Association status and 40–100% of the patients improved by ≥ 1 grade. Nine of 10 studies reported reductions in hospitalisation frequency and/or duration. When treated with PD, HF patients had fewer symptoms, lower hospital admissions and duration compared to diuretic therapy. However, there is inadequate evidence comparing PD versus UF or HD. Further studies comparing these modalities in diuretic-resistant HF should be conducted.

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Section: Resultsmentioning

confidence: 97%

“…In all, 31 articles (902 patients) were identified for inclusion in this review. 24 –28,31 –56 The flow diagram depicting the selection process is illustrated in Figure 1(a).…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…Table 3 also lists the parameters of the EC techniques (HD or UF) employed in four studies. This ranged from conventional HD 57 to UF 42,50 or a combination of both. 32…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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The use of peritoneal dialysis in heart failure: A systematic review

Chionh

Clementi²,

Poh

et al. 2020

Perit Dial Int

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Intermittent Peritoneal Dialysis: Urea Kinetic Modeling and Implications of Residual Kidney Function

et al. 2012

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♦ Background: Intermittent peritoneal dialysis (IPD) is an old strategy that has generally been eclipsed, in the home setting, by daily peritoneal therapies. However, for a select group of patients with exhausted vascular access or inability to receive PD at home, in-center IPD may remain an option or may serve as an incremental strategy before initiation of full-dose PD. We investigated the residual kidney clearance requirements necessary to allow thrice-weekly IPD regimens to meet current adequacy targets. ♦ Methods: The 3-pore model of peritoneal transport was used to examine 2 thrice-weekly IPD dialysis modalities: 5 -6 dwells with 10 -12 L total volume (low-dose IPD), and 50% tidal with 20 -24 L total volume (high-dose IPD). We assumed an 8-hour dialysis duration and 1.5% dextrose solution, with a 2-L fill volume, except in tidal mode. The PD Adequest application (version 2.0: Baxter Healthcare Corporation, Deerfield, IL, USA) and typical patient kinetic parameters derived from a large dataset [data on file from Treatment Adequacy Review for Gaining Enhanced Therapy (Baxter Healthcare Corporation)] were used to model urea clearances. The minimum glomerular filtration rate (GFR) required to achieve a total weekly urea Kt/V of 1.7 was calculated. ♦ Results: In the absence of any dialysis, the minimum residual GFR necessary to achieve a weekly urea Kt/V of 1.7 was 9.7 mL/min/1.73 m 2 . Depending on membrane transport type, the low-dose IPD modality met urea clearance targets for patients with a GFR between 6.0 mL/ min/1.73 m 2 and 7.6 mL/min/1.73 m 2 . Similarly, the high-dose IPD modality met the urea clearance target for patients with a GFR between 4.7 mL/min/1.73 m 2 and 6.5 mL/min/1.73 m 2 . ♦ Conclusions: In patients with residual GFR of at least 7.6 mL/min/1.73 m 2 , thrice-weekly low-dose IPD (10 L) achieved a Kt/V urea of 1.7 across all transport types. Increasing the IPD volume resulted in a decreased residual GFR requirement of 4.7 mL/min/1.73 m 2 (24 L, 50% tidal). In patients with residual kidney function and dietary compliance, IPD may be a viable strategy in certain clinical situations.

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Nonuremic Indication for Peritoneal Dialysis for Refractory Heart Failure in Cardiorenal Syndrome Type II: Review and Perspective

Nakayama

2013

Perit Dial Int

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Cardiorenal syndrome (CRS) type II is a serious condition in which chronic cardiac abnormalities cause worsening kidney function, leading to permanent chronic kidney damage. Management of CRS type II coupled with diuretic-resistant congestive heart failure (CHF) has been an issue of dispute. However, since the early 1990s, reports indicating the clinical usefulness of peritoneal dialysis (PD) as maintenance therapy for intractable CHF in this population have been accumulating. The present manuscript reviews the mechanisms by which kidney dysfunction develops within CHF, and then examines recent experiences of PD as chronic supportive therapy for intractable CRS type II, reviews the contributing mechanisms, and discusses the rationale for using PD as a new therapeutic approach in the nonuremic setting of CHF.

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Intermittent Outpatient Ultrafiltration for Severe Refractory Congestive Heart Failure

Cited by 3 publications

References 0 publications

The use of peritoneal dialysis in heart failure: A systematic review

The use of peritoneal dialysis in heart failure: A systematic review

Intermittent Peritoneal Dialysis: Urea Kinetic Modeling and Implications of Residual Kidney Function

Nonuremic Indication for Peritoneal Dialysis for Refractory Heart Failure in Cardiorenal Syndrome Type II: Review and Perspective

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