Lu Renhua, Muciño-Bermejo María-Jimena, Ribeiro Leonardo Claudino, Tonini Enrico, Estremadoyro Carla, Samoni Sara, Sharma Aashish, Zaragoza Galván José de Jesús, Crepaldi Carlo, Brendolan Alessandra, Ni Zhaohui, Rosner Mitchell H, Ronco Claudio
Department of Nephrology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China ; Nephrology, Dialysis and Transplantation of the San Bortolo Hospital, International Renal Research Institute of Vicenza, Vicenza, Italy.
Nephrology, Dialysis and Transplantation of the San Bortolo Hospital, International Renal Research Institute of Vicenza, Vicenza, Italy.
Cardiorenal Med. 2015 Apr;5(2):145-56. doi: 10.1159/000380915.
Refractory congestive heart failure (RCHF) is associated with a high mortality rate and is a major contributor to hospital admissions. Peritoneal dialysis (PD) is an option to control volume overload and perhaps improve outcomes in this challenging patient population. The aim of this systematic review is to describe the relative risk-benefit ratio based on data reported regarding the use of PD in RCHF. This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. An electronic search of PubMed, Embase, and the Cochrane Library was performed to identify relevant studies published from January 1951 to February 2014. Eligible studies selected were prospective or retrospective adult population studies on PD in the setting of RCHF. The following clinical outcomes were used to assess PD therapy: (1) hospitalization rates; (2) heart function; (3) renal function; (4) fluid overload, and (5) adverse clinical outcomes.
Of 864 citations, we excluded 843 citations and included 21 studies (n = 673 patients). After PD, hospitalization days declined significantly (p = 0.0001), and heart function improved significantly (left ventricular ejection fraction: p = 0.0013; New York Heart Association classification: p = 0.0000). There were no statistically significant differences in glomerular filtration rate after PD treatment in non-chronic kidney disease stage 5D patients (p = 0.1065). Among patients treated with PD, body weight decreased significantly (p = 0.0006). The yearly average peritonitis rate was 14.5%, and the average yearly mortality was 20.3%.
This systematic review suggests that PD may be an effective and safe therapeutic tool for patients with RCHF.
难治性充血性心力衰竭（RCHF）死亡率高，是导致住院的主要原因。腹膜透析（PD）是控制容量超负荷的一种选择，可能改善这类具有挑战性患者群体的预后。本系统评价的目的是根据有关RCHF患者使用PD的报告数据描述相对风险效益比。本研究按照系统评价和Meta分析的首选报告项目声明进行。对PubMed、Embase和Cochrane图书馆进行电子检索，以识别1951年1月至2014年2月发表的相关研究。入选的合格研究为RCHF患者PD的前瞻性或回顾性成年人群研究。以下临床结局用于评估PD治疗：（1）住院率；（2）心功能；（3）肾功能；（4）液体超负荷；（5）不良临床结局。
在864条引文中，我们排除了843条引文，纳入了21项研究（n = 673例患者）。PD治疗后，住院天数显著减少（p = 0.0001），心功能显著改善（左心室射血分数：p = 0.0013；纽约心脏协会分级：p = （此处原文有误，应为p = 0.0000））。非慢性肾脏病5D期患者PD治疗后肾小球滤过率无统计学显著差异（p = 0.1065）。接受PD治疗的患者体重显著下降（p = 0.0006）。每年腹膜炎发生率平均为14.5%，年平均死亡率为20.3%。
本系统评价提示，PD可能是RCHF患者有效且安全的治疗手段。
