Hedau S, Chakravarthi R, Reddy V
Department of Nephrology, Care Hospital, Hyderabad, Telangana, India.
Department of Nephrology, Star Hospital, Hyderabad, Telangana, India.
Indian J Nephrol. 2018 Jul-Aug;28(4):298-302. doi: 10.4103/ijn.IJN_12_17.
Diuretics are the mainstay of treatment of refractory heart failure. There is a high incidence of dyselectrolytemia and suboptimal response due to diuretic resistance. Ultrafiltration by peritoneal route can be a safe and effective alternative. This study aims to study the ultrafiltration by peritoneal route in refractory heart failure patients with respect to change in functional status, renal parameters, left ventricular ejection fraction, number of days of hospitalization, and level of myocardial depressant factors. This was a prospective observational study conducted in Nephrology Department of tertiary care hospital. We studied patients with refractory heart failure who had persistent symptoms requiring frequent admissions despite optimal medical decongestion or had dyselectrolytemia with worsening renal parameters. The data were collected at baseline and then after 6 months of starting ultrafiltration. A total of 30 participants were studied. All the patients were in NYHA functional status Class IV before peritoneal ultrafiltration. There was a significant improvement in functional status and only 14 patients (46%) had Class III to Class IV status after application of ultrafiltration. ( < 0.001) There was a significant improvement in duration of hospital stay (75.8 ± 43.3 days to 7.8 ± 12.4, > 0.001), serum creatinine (3.18 ± 0.98 to 2.16 ± 0.79 mg/dl, < 0.001), and left ventricular ejection fraction [29.3 ± 7.4 (%) to 48.5 ± 11.8 (%), < 0.0001] post ultrafiltration. There was also significant improvement in level of myocardial depressant factors (IL-1, IL-6, TNF alpha). Ultrafiltration by peritoneal route seems to be an effective alternative and should be offered to patients with chronic heart failure who are symptomatic despite maximal medical treatment.
利尿剂是难治性心力衰竭治疗的主要手段。由于利尿剂抵抗，电解质紊乱的发生率较高且反应欠佳。经腹膜途径超滤可能是一种安全有效的替代方法。本研究旨在探讨经腹膜途径超滤对难治性心力衰竭患者功能状态、肾脏参数、左心室射血分数、住院天数及心肌抑制因子水平的影响。这是一项在三级护理医院肾内科进行的前瞻性观察研究。我们研究了难治性心力衰竭患者，这些患者尽管接受了最佳的药物消肿治疗仍有持续症状需要频繁住院，或存在电解质紊乱且肾脏参数恶化。在基线时以及开始超滤6个月后收集数据。共研究了30名参与者。所有患者在腹膜超滤前均处于纽约心脏协会（NYHA）功能分级IV级。功能状态有显著改善，超滤后只有14名患者（46%）处于III级至IV级状态（<0.001）。超滤后住院时间（从75.8±43.3天降至7.8±12.4天，>0.001）、血清肌酐（从3.18±0.98降至2.16±0.79mg/dl，<0.001）和左心室射血分数[从29.3±7.4（%）升至48.5±11.8（%），<0.0001]均有显著改善。心肌抑制因子（IL-1、IL-6、肿瘤坏死因子α）水平也有显著改善。经腹膜途径超滤似乎是一种有效的替代方法，并应提供给尽管接受了最大程度药物治疗仍有症状的慢性心力衰竭患者。
