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Abstract: TH-PO293

Is There a Place for Peritoneal Dialysis in Treatment of Refractory Heart Failure?

Session Information

Category: Dialysis

  • 703 Dialysis: Peritoneal Dialysis

Authors

  • Gomes da silva, Ana Francisca, Hospital Dr. Nélio Mendonça, Funchal, Portugal
  • Calça, Rita, Hospital Santa Cruz, Lisbon, Portugal
  • Martins, Ana Rita Mateus, Hospital Santa Cruz, Lisbon, Portugal
  • Gaspar, Maria augusta Cabrita silva, Hospital Santa Cruz, Lisbon, Portugal
  • Branco, Patricia Quadros, Santa Cruz Hospital, Carnaxide, Portugal
Background

Ultrafiltration techniques have shown promise in the treatment of diuretic-resistant heart failure (HF). The aim of this study was to describe a single-center experience in the treatment of refractory HF patients with PD.

Methods

Retrospective study of 14 patients presenting symptoms and signs of severe refractory congestive HF despite optimal pharmacological therapy. Baseline characteristics and laboratory data were recorded. Charlson score and Doppler-echocardiogram results were collected at the beginning and end of follow-up period. PD adequacy was evaluated through peritoneal equilibrium test (PET) results.

Results

We followed a cohort of 14 patients with HF, all excluded as candidates for heart transplantation. 12 were males (85.7%) and 2 females (14.3%), with a median age of 72.13 (IQR 42.5 - 75.38) years. The mean following time was 52.5 ± 25.3 (range 18 – 95) months. Seven patients (50%) had hypertension, 7 (50%) were diabetic and 2 (14.3%) had hepatitis C infection. The etiology of HF was arterial hypertension in 7 patients (50%), ischemic cardiopathy in 3 (21.4%), valvular cardiopathy in 3 (21.4%) and in 1 patient (7.1%) congenital cardiopathy. Three patients (21.4%) had been previously treated with intermitent hemodiafiltration, which was suspended due to hemodynamic instability; the other 11 patients started PD ab initium. Symptoms of HF improved in 35.7% (N=5) of patients, with an upgrade of New York Heart Association (NYHA) Functional Classification and improvement in ejection fraction (EF). At the beginning of PD treatment the mean Charlson score value was 5.7 ± 2.3, wich reduced to 5.3 ± 2.6 by the end of observation time. There was a positive correlation between the first and the last Charlson score acessed (r=0.984; n=12; p<0.001). Six patients presented 1 episode of decompensated heart failure needing hospitalization, with a median length of stay of 2 (IQR 0 - 6.75) days. During the observation period seven patients were transferred to HD. In 3 cases this was lead by peritonitis episodes and in 4 by ultrafiltration failure. Two patients died, one from an acute hemorrhagic stroke and the other with a septic shock.

Conclusion

PD treatment in refractory HF, in addition to optimal pharmacological therapy, seems to be effective, since it improves quality of life and functional class.