Abstract: TH-PO295
Peritoneal Dialysis for Refractory Heart Failure; Decongestion, Cardiac Function, and Functional Status: A Reappraisal
Session Information
- Peritoneal Dialysis: CVD, Fluid, Nutrition
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 703 Dialysis: Peritoneal Dialysis
Authors
- Chamarthi, Gajapathiraju, University of Florida, Gainesville, Florida, United States
- Bejjanki, Harini, University of Florida, Gainesville, Florida, United States
- Kazory, Amir, University of Florida, Gainesville, Florida, United States
Background
Congestion is an integral component of heart failure (HF) syndrome. Growing evidence points to peritoneal dialysis (PD) as an efficient therapeutic modality for management of fluid overload in refractory HF. Improvement in left ventricular ejection fraction (LVEF) is a frequently reported benefit of PD in this setting. We sought to explore whether the observed salutary impact of PD on cardiac function and functional status is due to efficient decongestion (i.e. Frank-Starling law).
Methods
Available data from contemporary clinical trials of PD in HF (performed between January 2010 and May 2019) that included more than 20 patients were selected and reviewed. Those studies evaluating the impact of PD on LVEF and volume status (assessed through changes in weight) in patients without end-stage kidney disease were included. Pertinent data were extracted and using Pearson product-moment correlation, the degree of linear dependence and correlation between these two variables was determined.
Results
Out of 11 clinical studies meeting the criteria, 1 was a duplicate and 3 did not have the needed data; 7 studies (4 retrospective and 3 prospective) with a total of 399 participants were included. The mean age was 71 years, and the mean baseline LVEF and weight were 35.1% and 76 Kg respectively. The median follow up was 14 months. There was substantial variation in the reporting of time point for cardiac function, functional status, and weight. LVEF changes ranged from -1.4 to +6.0 % (mean 1.51 ± 2.71) and weight changes ranged from -8.3 to +3.3 Kg (mean 2.09 ± 3.95). No correlation was observed between changes in LVEF and weight (r= 0.39, p= 0.37). All studies that evaluated functional status reported on its improvement after PD therapy.
Conclusion
While PD therapy for management of refractory HF is associated with improvement in cardiac function and functional status, data from contemporary trials suggests that changes in LVEF and weight do not have a strong correlation. Therefore, it is unlikely that efficient decongestion could fully explain the beneficial impact of PD on cardiac function. Since these studies did not included nutritional indices, an alternative explanation is that the relationship between weight and volume status in HF may be confounded by changes in in muscle mass after initiation of PD therapy.