• 作者：Julio N¨²?ez ; Miguel Gonz¨¢lez ; Gema Mi?ana ; Rafael Garcia-Ram¨®n ; Juan Sanchis ; Vicent Bod¨ª ; Eduardo N¨²?ez ; Maria Jes¨²s Puchades ; Patricia Palau ; Pilar Merlos ; Beatriz Mascarell ; Alfonso Miguel
• 关键词：DPCA ; diá ; lisis peritoneal continua ambulatoria ; IC ; insuficiencia cardiaca ; ICA ; insuficiencia cardiaca aguda ; ICC ; insuficiencia cardiaca congestiva
• 刊名：Revista Espa?ola de Cardiolog¡§aa
• 出版年：2012
• 出版时间：November, 2012
• 年：2012
• 卷：65
• 期：11
• 页码：986-995
• 全文大小：404 K

Introduction and objectives

Peritoneal dialysis has been proposed as a therapeutic alternative for patients with refractory congestive heart failure. The objective of this study was to assess its effect on long-term clinical outcomes in patients with advanced heart failure and renal dysfunction.

Methods

A total of 62 patients with advanced heart failure (class III/IV), renal dysfunction (glomerular filtration<60 mL/min/1.73 m²), persistent fluid congestion despite loop diuretic treatment and at least 2 previous hospitalizations for heart failure were invited to participate in a continuous ambulatory peritoneal dialysis program. Of these, 34 patients were excluded and adjudicated as controls. The most important reasons for exclusion were refusal to participate, inability to perform the technique and abdominal wall defects. The primary endpoint was all-cause mortality and the composite of death/readmission for heart failure. To account for baseline imbalance, a propensity score was estimated and used as a weight in all analyses.

Results

The peritoneal dialysis (n=28) and control groups (n=34) were alike in all baseline covariates. During a median follow-up of 16 months, 39 (62.9 % ) died, 21 (33.9 % ) patients were rehospitalization for heart failure, and 42 (67.8 % ) experienced the composite endpoint. In the propensity score-adjusted models, peritoneal dialysis (vs control group) was associated with a substantial reduction in the risk of mortality using complete follow-up (hazard ratio=0.40; 95 % confidence interval, 0.21-0.75; P=.005), mortality using days alive and out of hospital (hazard ratio=0.39; 95 % confidence interval, 0.21-0.74; P=.004) and the composite endpoint (hazard ratio=0.32; 95 % confidence interval, 0.17-0.61; P=.001).

Conclusions

In refractory congestive heart failure with concomitant renal dysfunction, peritoneal dialysis was associated with long-term improvement in clinical outcomes.

Full English text available from: