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Abstract: FR-PO526

A Case of Successful Palliative Care With Peritoneal Dialysis for Severe Cyanotic Congenital Heart Disease

Session Information

Category: Dialysis

  • 702 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

  • Kadota, Nozomi, St. Luke's International Hospital, Tokyo, Japan
  • Ito, Yugo, St. Luke's International Hospital, Tokyo, Japan
  • Shimoyama, Kotaro, St. Luke's International Hospital, Tokyo, Japan
  • Konishi, Kasumi, St. Luke's International Hospital, Tokyo, Japan
  • Fujimaru, Takuya, St. Luke's International Hospital, Tokyo, Japan
  • Taki, Fumika, St. Luke's International Hospital, Tokyo, Japan
  • Nagahama, Masahiko, St. Luke's International Hospital, Tokyo, Japan
  • Nakayama, Masaaki, St. Luke's International Hospital, Tokyo, Japan
Introduction

Peritoneal dialysis (PD) is an optimal renal replacement therapy (RRT) for kidney dysfunction by cardio-renal syndrome and unstable hemodynamics. However, there is little evidence that PD is also effective for terminal care in heart failure patients to improve quality of life (QOL). To our knowledge, this is the first case report that PD enabled a cyanotic congenital heart disease patient to pursue his palliative care at home, maintaining better QOL without aggravation of heart failure.

Case Description

A 50-year-old man who was diagnosed with tricuspid atresia and underwent Blalock-Taussig shunt in his infancy was consulted to our clinic with his eGFR of 20 ml/min/1.73 m2. His chronic kidney disease was exacerbated gradually. Two years later, as his volume overload was uncontrollable without continuous intravenous inotropic agent and diuretics, he was hospitalized as often as twice a month. As a result of patient-centered team discussion, PD was selected for his RRT, considering for reduction his cardiac burden. On admission, he was classified as New York Heart Association (NYHA) class IV. His blood pressure was 88/52 mmHg, and oxygen saturation was 78% on room air. After the initiation of PD, fluid overload and dyspnea improved to NYHA class II. It allowed him to spend rest of his life at home with better QOL without hospitalization for heart failure for three years. At last, atrial fibrillation, untreatable with anti-arrhythmia drugs nor defibrillation, caused low output syndrome. Although he had no symptoms of uremia nor difficulty breathing, he died of heart failure at the age of 56.

Discussion

In general, patients with congenital heart disease with Eisenmenger syndrome and NYHA classification IV are expected to have shorter life spans than those of healthy population for more than 40 years. Among those patients, the main cause of death is heart failure. Declined kidney function is a risk of hospitalization. For this case, hemodialysis might have worsened his hemodynamics or susceptibility to blood stream infection. For the patients of cardio-renal syndrome due to cyanotic heart disease, PD could be the best choice to pursue better palliative care, maintaining QOL.