Abstract: TH-PO863
Therapeutic Experiences of Peritoneal Dialysis Therapy for Patients with Severe Heart Failure and/or Liver Cirrhosis
Session Information
- Peritoneal Dialysis - I
November 02, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Dialysis
- 608 Peritoneal Dialysis
Authors
- Sato, Eiichi, Dokkyo Medical University, Koshigaya Hospital, Koshigaya, Saitama prefecture, Japan
- Nakamura, Tsukasa, Shinmatsudo Central General Hospital, Matsudo city, Japan
- Ono, Takao, Shinmatsudo Central General Hospital, Matsudo city, Japan
- Degawa, Manaka, Shinmatsudo Central General Hospital, Matsudo city, Japan
- Lu, Hongmei, Shinmatsudo Central General Hospital, Matsudo city, Japan
- Matsumura, Daisuke, Shinmatsudo Central General Hospital, Matsudo city, Japan
- Nomura, Mayumi, Shinmatsudo Central General Hospital, Matsudo city, Japan
- Amaha, Mayuko, Shinmatsudo Central General Hospital, Matsudo city, Japan
- Fujii, Akiko, Dokkyo Medical University, Koshigaya Hospital, Koshigaya, Saitama prefecture, Japan
- Ono, Yuko, Dokkyo Medical University, Koshigaya Hospital, Koshigaya, Saitama prefecture, Japan
- Ueda, Yoshihiko, Dokkyo Medical University, Koshigaya Hospital, Koshigaya, Saitama prefecture, Japan
Background
Peritoneal Dialysis (PD) is one type of renal replacement therapy for end-stage renal failure, however, some reports have described the application of PD for severe heart failure and liver cirrhosis using the slight change in hemodynamics caused by the gradual dehydration effect. We describe our experience of introducing PD to patients with severe heart failure or refractory ascites with liver cirrhosis.
Methods
The study included 6 out of 11 patients for whom PD was introduced at our department over the past year. Three patients had severe heart failure and difficulty in weaning off extracorporeal circulation, one patient had refractory ascites caused by liver cirrhosis, and two patients had both conditions.
Results
The subject sample consisted of four male and two female patients, aged 78.3 ± 5.0 years (mean ± standard deviation), and the underlying disease was dilated cardiomyopathy concurrent with diabetes, with ischemic heart disease in four patients, non-alcoholic steatohepatitis in one patient, and hypoalbuminemia in one patient. The mean estimated glomerular filtration rate was 21.8 ± 2.8 ml/min/1.73m2. The mean survival period was 60.7 ± 14.5 days, with two fatal cases at 65 days and 45 days, respectively, both of which were caused by sepsis unrelated to PD. In five patients weaning off extracorporeal circulation was possible, and in one patient, who was unsuited to extracorporeal circulation, heart failure was managed by PD alone and the patient was successfully weaned off the mechanical ventilator. Brain natriuretic peptide was 516.0 ± 172.9 pg/mL prior to PD introduction, and 316.7 ± 82.3 pg/mL following PD introduction, with a significant decrease (p = 0.01).
Conclusion
In patients with chronic heart failure or renal failure concurrent with liver cirrhosis, dehydration management is often performed by extracorporeal circulation, however in many instances, hemodynamics become unstable, making dehydration difficult. At our department, in such cases, it is expected that PD will achieve gradual dehydration, and we experienced cases in which PD enabled CHDF weaning and the control of heart failure and refractory ascites. The effectiveness of PD was suggested as a means of fluid management in severe heart failure and refractory ascites.