Division of Nephrology, Department of Internal Medicine, Akdeniz University Medical School, Antalya, Turkey.
Int Urol Nephrol. 2012 Jun;44(3):963-9. doi: 10.1007/s11255-012-0147-7. Epub 2012 Mar 3.
Refractory congestive heart failure (RCHF), due to its high mortality and hospitalization rates, is a growing health problem. In this study, as an alternative and/or supportive treatment to conventional medical therapies, we have evaluated the clinical value of peritoneal ultrafiltration, performed as a single daily exchange with icodextrin or conventional dextrose-based peritoneal dialysis solutions, in elderly patients with RCHF.
This was an observational study of 6 elderly patients with RCHF and non-terminal chronic kidney disease (CKD). Their mean age was 72.8 ± 4.9 years. Four of the six patients had NYHA class 4 and two had NYHA class 3 RCHF and a medical history of 18.6 ± 14.9 days/year hospitalization on average, due to decompensated congestive heart failure (CHF). Their baseline glomerular filtration rate, as calculated by the MDRD formula was 49.4 ± 14.6 mL/min/1.73 m(2). During hospitalization, patients were initially treated with several sessions of continuous veno-venous hemofiltration and, following the achievement of hemodynamic stabilization, peritoneal ultrafiltration was initiated as the maintenance ultrafiltration modality. Patients were followed up monthly in terms of their clinical status, hospitalization rates, weight changes, serum sodium levels, and renal function. Echocardiographic changes were also evaluated every 3 months.
All patients tolerated peritoneal ultrafiltration well, their functional status improved by 1 or 2 NYHA classes to reach a mean of NYHA class 2 CHF status. During the follow-up period, with a mean daily ultrafiltration rate of 850 ± 176 mL, no hospitalization for decompensated CHF or acute renal failure was required. The patients' renal function was well preserved, with a mean GFR of 49 ± 14.6 mL/min/1.73 m(2) at baseline and 51.6 ± 22.9 mL/min/1.73 m(2) at the 6th month of the study. Additionally, their mean serum sodium levels increased from 128 ± 5.7 mEq/L to 138 ± 5 mEq/L. Echocardiographic evaluation did not show any significant changes during the observation period. No peritonitis or other non-infectious complication of chronic peritoneal dialysis was seen in any of the patients.
Peritoneal ultrafiltration seems to be an efficient and safe procedure and a treatment of choice in elderly patients with RCHF without non-terminal CKD. Peritoneal ultrafiltration improves the quality of life and the effort capacity, and reduces hospitalization rates due to decompensated heart failure and acute renal failure.
难治性充血性心力衰竭（RCHF）由于其高死亡率和住院率，是一个日益严重的健康问题。在这项研究中，作为对常规医学治疗的替代和/或支持治疗，我们评估了腹膜超滤的临床价值，将其作为每日单次交换，使用艾考糊精或传统的基于葡萄糖的腹膜透析液进行，在老年 RCHF 患者中进行。
这是一项对 6 名老年 RCHF 和非终末期慢性肾脏病（CKD）患者的观察性研究。他们的平均年龄为 72.8 ± 4.9 岁。6 名患者中有 4 名 NYHA 分级 4 级，2 名 NYHA 分级 3 级，平均每年因失代偿性充血性心力衰竭（CHF）住院 18.6 ± 14.9 天。他们的肾小球滤过率基线，根据 MDRD 公式计算为 49.4 ± 14.6 mL/min/1.73 m(2)。住院期间，患者最初接受了几次连续静脉-静脉血液滤过治疗，在达到血流动力学稳定后，开始进行腹膜超滤作为维持超滤方式。每月对患者的临床状况、住院率、体重变化、血清钠水平和肾功能进行随访。每 3 个月评估一次超声心动图变化。
所有患者均能很好地耐受腹膜超滤，其功能状态提高了 1 或 2 个纽约心功能分级（NYHA），达到平均 NYHA 2 级心力衰竭状态。在随访期间，平均每日超滤率为 850 ± 176 mL，无需因失代偿性 CHF 或急性肾衰竭而住院。患者的肾功能得到很好的保留，肾小球滤过率基线时为 49 ± 14.6 mL/min/1.73 m(2)，研究第 6 个月时为 51.6 ± 22.9 mL/min/1.73 m(2)。此外，他们的平均血清钠水平从 128 ± 5.7 mEq/L 增加到 138 ± 5 mEq/L。在观察期间，超声心动图评估未显示任何显著变化。在任何患者中均未观察到腹膜炎或其他慢性腹膜透析的非感染性并发症。
腹膜超滤似乎是一种有效且安全的方法，是老年 RCHF 且无非终末期 CKD 患者的首选治疗方法。腹膜超滤可改善生活质量和活动能力，并降低因失代偿性心力衰竭和急性肾衰竭而导致的住院率。
