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Kidney Week

Abstract: SA-PO726

Peritoneal Dialysis as a Treatment for Diuretic Resistant, Refractory Heart Failure in Patients with CKD: A Single Centre Experience

Session Information

  • Peritoneal Dialysis - II
    November 04, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Dialysis

  • 608 Peritoneal Dialysis

Authors

  • Mahdi, Amar Monaf, University Hospital of North Midlands, Stoke-On-Trent, United Kingdom
  • Menon, Madhavan S., University Hospital of North Midlands, Stoke-On-Trent, United Kingdom
  • Capper, Helen Patricia, University Hospital of North Midlands, Stoke-On-Trent, United Kingdom
  • Satchithananda, Duwarakan K, university hospital north midlands, Staffordshire, United Kingdom
  • Davies, Simon J., University Hospital of North Midlands, Stoke-On-Trent, United Kingdom
Background

To assess the role and feasibility of peritoneal dialysis (PD) on clinical outcomes in patients with diuretic resistant refractory heart failure (HF) and Chronic Kidney Disease (CKD).

Methods

Retrospective data and case-note review of 20 patients with HF and CKD started on PD for fluid management. Setting: UK PD unit with an established assisted APD programme. The period of the study was between November 2010 and January 2017. Patients with eGFR <15ml/min were only included if believed to have decline in eGFR as a result of decompensating heart failure (cardio-renal syndrome).

Results

Mean age was 72±9 years, 18 (90%) aged 65 year or older, 85% male. Mean eGFR at PD initiation was 23.9±12.47 and 6 (30%) patients had eGFR of ≤15 ml/min at start of treatment. The aetiology of heart failure was ischaemic in 17 patients (85%). All patients had NYHA class III or IV, and diuretic resistance. Recent estimated ejection fraction (EF) before starting PD was available in 15 patients (EF 10%-60%), 46.6%: EF<35%, 33.3%: EF 35-45% and 20%: EF >45%.
All PD catheters were inserted using Seldinger technique and had a patency rate of 95%. The median duration of PD was 9.35 months (IQR 3.41-16.08). During the study period 14 patients (70%) died, 30% (6 patients) died within the first year, and overall the median survival was 14.8 months (IQR 4.81-24.89) .

Among those who has lasted on PD for at least 12 months the mean number of hospital visits (days per year) for HF or PD related issues in the year before starting PD (52.43±27.8) was significantly higher than the year after starting PD (6.86±5.87) {p=0.007}.
The median eGFR has shown a rise by 0.5 ml/min/month over the first 3 months and a decline by 0.83 ml/min/month at 6 months.

Conclusion

Peritoneal dialysis could serve as a feasible therapeutic intervention to reduce hospital admissions in fluid management in heart failure patients where symptom control with conventional medical treatment becomes a challenge.