Nephrology and Hypertension Institute, Sheba Medical Center and Sackler Faculty of Medicine, Tel-Hashomer, Israel.
Blood Purif. 2013;35(4):285-94. doi: 10.1159/000351202. Epub 2013 May 24.
Peritoneal dialysis (PD) is increasingly used for long-term management of refractory congestive heart failure (CHF). In this study, we investigated the outcome of patients with refractory CHF treated with PD, aiming to identify potential prognostic factors for long term-survival.
This was a prospective observational study over a period of 42 months which included 37 refractory CHF patients.
Median survival on PD was 14 months (1-41 months). Long survivors had serum sodium >132 mEq/l (p < 0.001), serum albumin >3.2 g/dl (p < 0.001) and hospitalization rate <2 days per month a year before starting the treatment (p = 0.008). Patients in the lowest survival quartile had lower serum albumin (2.8 vs. 3.5 g/dl in longer survivors, p = 0.003) and serum sodium (126 vs. 137 mEq/l, p < 0.0001), higher serum leukocyte count (7,500 vs. 6,800/μl in long survivors, p = 0.033), higher glomerular filtration rate (39.4 vs. 29.9 ml/min/1.73 m(2), p = 0.035), had more hospitalization before starting the treatment (3.4 vs. 1.9 days per month, p = 0.003) and lower estimated left ventricular mass index (113 vs. 137 g/m(2), p = 0.035). Long-term survivors demonstrated significant improvement in the New York Heart Association functional class by a median of one class, reduced hospitalization rate by 55% and decrease in dependence on intravenous diuretics and vasoactive medications (73% drop in CHF day care visits during the first year of treatment).
Survival of patients with refractory CHF treated with PD is highly variable. Serum sodium, serum albumin and hospitalization rate are important prognostic factors for long-term survival. Long survivors demonstrated improved functional status, reduced hospitalization and mortality rates.
腹膜透析（PD）越来越多地用于治疗难治性充血性心力衰竭（CHF）。在这项研究中，我们调查了接受 PD 治疗的难治性 CHF 患者的结局，旨在确定长期生存的潜在预后因素。
这是一项为期 42 个月的前瞻性观察性研究，共纳入 37 例难治性 CHF 患者。
PD 治疗的中位生存时间为 14 个月（1-41 个月）。长期生存者的血清钠>132 mEq/L（p<0.001）、血清白蛋白>3.2 g/dl（p<0.001）和治疗前每年住院时间<2 天/月（p=0.008）。在最低生存四分位数的患者中，血清白蛋白较低（2.8 与较长生存者的 3.5 g/dl，p=0.003）和血清钠较低（126 与 137 mEq/L，p<0.0001），白细胞计数较高（7500 与较长生存者的 6800/μl，p=0.033），肾小球滤过率较高（39.4 与 29.9 ml/min/1.73 m2，p=0.035），治疗前住院时间较长（3.4 与 1.9 天/月，p=0.003），左心室质量指数估计值较低（113 与 137 g/m2，p=0.035）。长期生存者的纽约心脏协会功能分级中位数提高了 1 级，住院率降低了 55%，并减少了对静脉利尿剂和血管活性药物的依赖（治疗第一年心衰日间护理就诊次数减少了 73%）。
接受 PD 治疗的难治性 CHF 患者的生存率差异很大。血清钠、血清白蛋白和住院率是长期生存的重要预后因素。长期生存者的功能状态改善，住院和死亡率降低。
