Ultrafiltration by peritoneal route in refractory chronic congestive cardiac failure

Hedau, Santosh; Chakravarthi, Rajasekara; Reddy, Veena

doi:10.4103/ijn.ijn_12_17

Cited by 6 publications

(7 citation statements)

References 21 publications

(24 reference statements)

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“…PD is effective in increasing quality of life in diuretic unresponsive patients in terms of improving NYHA functional class and less hospitalization rates as observed in the present study. These findings are consistent with previous studies and meta‐analyses [7–27]. Fröclich et al conducted a study where PD treatment is compared with medical treatment in refractory HF patients.…”

Section: Discussionsupporting

confidence: 90%

Peritoneal dialysis for refractory heart failure: A single‐center experience

et al. 2022

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Introduction: Heart failure (HF) is a disease associated with poor quality of life. Peritoneal dialysis (PD) can be an alternative in the treatment of these patients to overcome fluid overload. The objective of this study is to observe the effects of PD in refractory HF patients. Methods: We conducted an observational study including 10 patients with refractory congestive HF. PD started solely for fluid overload. Patients' baseline parameters were compared with follow-up parameters. Results: Median age was 57.5 (44.8-64.3) years. Median left ventricular ejection fraction was 20% (18.8-31.3), and all patients had right ventricular dysfunction. Median estimated glomerular filtration rate was 51.2 (43.8-101.3) ml/min/1.73 m 2 .Two patients (20%) died during the follow-up period. New York Heart Association (NYHA) functional class decreased significantly from a median of 4 to 2,1 and 1 in the 3rd, 6th, and 12th months, respectively (p ≤ 0.01 for all from baseline). Number and length of hospitalization decreased significantly after treatment (number from a median of 3 to 0, p = 0.013; days from 50.5 to 0, p = 0.028). Conclusion:PD significantly reduced NYHA functional class, number and days of hospitalization for HF. It could be a reasonable option in chronic treatment of patients with refractory HF.

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Section: Discussionsupporting

confidence: 90%

Peritoneal dialysis for refractory heart failure: A single‐center experience

et al. 2022

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“…Cardiocytes are nucleated cells in the myocardium that can secrete pro-inflammatory cytokines in response to myocardial stress or injury [ 19 ]. IL-6 and TNF- α have relevance to functional New York Heart Association (NYHA) class in systolic heart failure [ 20 ]. In addition, IL-6 and TNF- α serve as independent predictors of mortality in patients with heart failure [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Influence of Dexmedetomidine on Myocardial Injury in Patients with Simultaneous Pancreas-Kidney Transplantation

Dong

Zhang

et al. 2022

Evidence-Based Complementary and Alternative Medicine

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Background. Diabetes is one of the most common chronic diseases in the world. End-stage renal disease (ESRD) caused by diabetes is the most serious long-term complication. The main cause of death in patients with simultaneous pancreas-kidney transplantation (SPKT) is cardiovascular disease. Although dexmedetomidine (Dex) has unique advantages in heart protection against ischaemic/reperfusion injury, few clinical studies have been conducted on its cardioprotective effect in SPKT. This study aimed to explore the influence of Dex on myocardial injury in patients undergoing SPKT and to analyze its possible mechanism. Methods. A randomized controlled trial (RCT) was performed from July 1, 2018 to December 1, 2020. Eighty patients, regardless of gender, scheduled for SPKT were randomly allocated into a Dex group (D group) receiving Dex at a rate of 1 µg/kg for 10 minutes before anaesthesia induction and then continuous infusion at 0.5 µg/kg/hour until the end of surgery and control group (C group) receiving equivalent capacity of saline. Serum cardiac troponin I (cTnI), creatine kinase isoenzyme (CK-MB), tumour necrosis factor-α (TNF-α), and interleukin-6 (IL-6) were recorded at 5 minutes after anaesthesia induction (baseline,T0), 5 minutes before renal arteriovenous opening (T1), 30 minutes after renal arteriovenous opening (T2), 30 minutes after pancreatic related arteriovenous opening (T3), immediately after surgery (T4), 4 hours after surgery (T5), and 24 hours after surgery (T6). Adverse cardiovascular events were recorded during the perioperative period. Changes in ECG S-T segments and T waves were monitored at T0–T6. Myocardial infarction and percutaneous coronary intervention were recorded with an average follow-up of one year. Results. Compared with T0, TNF-α and IL-6 concentrations significantly increased at T1–T6 in the C and D groups ( P < 0.05 ). IL-6 concentration increased significantly after renal artery opening and reached the peak after the opening of pancreatic blood vessels. Compared with the C group, TNF-α, and IL-6 concentrations were significantly reduced in group D at T2–T6 ( P < 0.05 ). Compared with T0, cTnI and CK-MB concentrations were significantly increased at T3–T6 in the C and D groups ( P < 0.05 ). cTnI and CK-MB concentrations increased significantly after the opening of renal artery, and reached the peak after the opening of pancreatic blood vessels. Compared with the C group, cTnI and CK-MB concentrations were significantly reduced in the D group at T3–T6 ( P < 0.05 ). There was no significant difference in patient characteristics amongst groups, including the proportion of intraoperative vasoactive drug use and adverse cardiovascular events during the follow-up period. Heart rate, mean blood pressure, central venous pressure, and cardiac output were not remarkably different between the two groups at any time point. Conclusions. Perioperative reperfusion could aggravate myocardial injury in SPKT. Dex may be considered a way to reduce myocardial injury caused by inflammatory action by decreasing the release of inflammatory factors. Trial Registration Number: Chinese Clinical Trial Registry ID: ChiCTR2200060084.

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“…Improvement in LVEF after initiation of PD has been reported by several authors [42,51,61,85], while others failed to find a significant change [43]. However, it is essential to remark that the studies with the largest populations so far were able to report such an improvement [42,61].…”

Section: Ventricular Function and Pdmentioning

confidence: 89%

Peritoneal dialysis in heart failure: focus on kidney and ventricular dysfunction

Morales¹,

Barbosa²,

Farré³

2021

Rev. Cardiovasc. Med.

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Heart failure is a significant health problem worldwide. Despite all the new therapies available nowadays, many patients will reach advanced stages of the disease. Diuretic resistance, kidney dysfunction, and refractory congestion, all highly prevalent in advanced heart failure, frequently complicate the situation, making it more challenging to manage. Ultrafiltration through hemodialysis or peritoneal dialysis can be alternative options to treat fluid overload. Peritoneal dialysis has gained increased interest in the last decades due to several benefits such as functional class improvement, reduction in hospital admissions, improvement in quality of life, and even a reduction in mortality shown by numerous cohort studies. However, the majority of the studies were observational and with a limited number of patients. In addition, the optimal timing for the initiation of this type of therapy and the subgroup of patients who would benefit the most from it is unknown. Hence, randomized controlled trials in this subject are urgently needed. We aim to review the contemporary evidence of peritoneal dialysis in patients with heart failure and diuretic resistance across the spectrum of ventricular dysfunction and degree of renal dysfunction.

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Ultrafiltration by peritoneal route in refractory chronic congestive cardiac failure

Cited by 6 publications

References 21 publications

Peritoneal dialysis for refractory heart failure: A single‐center experience

Peritoneal dialysis for refractory heart failure: A single‐center experience

Influence of Dexmedetomidine on Myocardial Injury in Patients with Simultaneous Pancreas-Kidney Transplantation

Peritoneal dialysis in heart failure: focus on kidney and ventricular dysfunction

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