Ponce Daniela, Góes Cassiana, Oliveira Mariele, Balbi Andre
Botucatu School of Medicine - UNESP, Internal Medicine, Botucatu, Brazil
Botucatu School of Medicine - UNESP, Internal Medicine, Botucatu, Brazil.
Perit Dial Int. 2017 Sep-Oct;37(5):578-583. doi: 10.3747/pdi.2016.00217.
This study aimed to explore the role of high-volume peritoneal dialysis (HVPD) in cardiorenal syndrome (CRS) type 1 patients in relation to metabolic and fluid control and outcome. Sixty-four patients were treated by HVPD (prescribed Kt/V = 0.50/session), flexible catheter and cycler. Mean age was 68.8 ± 15.4 years, 54.7% needed intravenous inotropic agents and/or intravenous vasodilators, 31.2% were on mechanical ventilation, acute coronary syndrome (ACS) was the main cause of acute disease heart failure (ADHF) 48.3%, median left ventricular ejection fraction (LVEF) was 38% and the main dialysis indications were uremia and hypervolemia. Blood ureic nitrogen and creatinine levels stabilized after 4 sessions at around 50 and 4 mg/dL, respectively. Negative fluid balance (FB) and ultrafiltration (UF) increased progressively and stabilized around 2.6 L and -2.5 L/day, respectively. Weekly-delivered Kt/V was 3.0 ± 0.42, and 32.8% died. There was a significant difference between the survivors (S) and non-survivors (NS) in age (71.4 ± 15.7 vs 63.6 ± 17.6, < 0.001), main diagnosis of ADHF (ACS: 76.2 vs 34.8%, = 0.04), mechanical ventilation (52.4 vs 20.1%, = 0.03), fluid overload (FO) at predialysis moment (52.4 vs 25.6%, = 0.04), and FB and UF from the 2 to 5 dialysis session. In conclusion, HVPD treatment was effective in CRS type 1 patients, allowing adequate metabolic and fluid control. Age, ACS, FO and positive FB after 2 HVPD sessions were higher in NS patients.
本研究旨在探讨高容量腹膜透析（HVPD）在1型心肾综合征（CRS）患者中对代谢和液体控制及预后的作用。64例患者接受了HVPD治疗（规定的Kt/V = 0.50/次），采用柔性导管和循环器。平均年龄为68.8±15.4岁，54.7%的患者需要静脉注射正性肌力药物和/或静脉血管扩张剂，31.2%的患者接受机械通气，急性冠状动脉综合征（ACS）是急性失代偿性心力衰竭（ADHF）的主要病因，占48.3%，左心室射血分数（LVEF）中位数为38%，主要透析指征为尿毒症和高血容量。4次透析后血尿素氮和肌酐水平分别稳定在约50和4mg/dL。负液体平衡（FB）和超滤量（UF）逐渐增加，分别稳定在约2.6L和-2.5L/天。每周的Kt/V为3.0±0.42，32.8%的患者死亡。存活者（S）和非存活者（NS）在年龄（71.4±15.7 vs 63.6±17.6，P<0.001）、ADHF的主要诊断（ACS：76.2% vs 34.8%，P = 0.04）、机械通气（52.4% vs 20.1%，P = 0.03）、透析前的液体超负荷（FO）（52.4% vs 25.6%，P = 0.04）以及第2至5次透析期间的FB和UF方面存在显著差异。总之，HVPD治疗对1型CRS患者有效，可实现充分的代谢和液体控制。NS患者的年龄、ACS、FO以及2次HVPD治疗后的正性FB更高。
