腹膜透析在老年心肾综合征伴心力衰竭患者中的治疗作用：一项病例系列报告。

Peritoneal dialysis as a therapeutic solution in elderly patients with cardiorenal syndrome and heart failure: A case-series report.

机构信息

First Cardiology Clinic, School of Medicine, Hippokratio Hospital, University of Athens, Athens, Greece.

Peritoneal Dialysis Unit Nephrology Clinic, Hippokration Hospital, Athens, Greece.

出版信息

Hellenic J Cardiol. 2020 Mar-Apr;61(2):73-77. doi: 10.1016/j.hjc.2019.04.010. Epub 2019 May 2.

DOI:10.1016/j.hjc.2019.04.010

PMID:31055051

Abstract

BACKGROUND

The aim of this work was to evaluate the impact of peritoneal dialysis (PD) on venous congestion, right ventricular function, pulmonary artery systolic pressure (PASP), and clinical functional status in elderly patients with cardiorenal syndrome (CRS) and chronic heart failure (HF).

METHODS

A case series of 21 (17 males, age 70 ± 11 years) consecutive patients with HF along with diuretic resistance and right ventricular dysfunction (median renal failure duration 60 months, range 13-287 months, mean ejection fraction 36 ± 11%) having been engaged in PD; 76% of the patients were under automated peritoneal dialysis (APD), whereas the rest were under continuous ambulatory PD (CAPD). Patients' PASP and central venous pressure (CVP) - through compression sonography - and body weight were evaluated before initiating the PD program and at 6 and 12 months.

RESULTS

During the follow-up period, the mortality rate was 8 deaths out of 21 patients (38%) A significant reduction by 29.9% in PASP levels (p = 0.013) and by 42% in CVP levels (p < 0.001), and in right ventricular function assessed by tricuspid annulus tissue Doppler velocity (p = 0.04) was observed, whereas patients' weight increased by 3.7% (p = 0.001). New York Heart Association class improved in 12 patients, whereas in the remaining patients, it remained constant (p = 0.046). In 8 patients, complications were reported (mainly presence of Staphylococcus aureus). In conclusion, PD seems to confer a substantial benefit in clinical status, which is in line with improvement in venous congestion and right ventricular systolic pressure among elderly patients with HF along with CRS.

摘要

背景

本研究旨在评估腹膜透析（PD）对老年心力肾综合征（CRS）合并慢性心力衰竭（HF）患者静脉淤血、右心室功能、肺动脉收缩压（PASP）和临床功能状态的影响。

方法

对 21 例（男 17 例，年龄 70 ± 11 岁）HF 患者进行了病例系列研究，这些患者均存在利尿剂抵抗和右心室功能障碍，且已接受 PD 治疗（中位肾功能衰竭持续时间 60 个月，范围 13-287 个月，平均射血分数 36 ± 11%）；76%的患者接受自动化腹膜透析（APD），其余患者接受持续非卧床腹膜透析（CAPD）。在开始 PD 治疗方案前和 6 个月、12 个月时，通过压缩超声检查评估患者的 PASP 和中心静脉压（CVP）以及体重。

结果

在随访期间，21 例患者中有 8 例（38%）死亡。PASP 水平降低了 29.9%（p = 0.013），CVP 水平降低了 42%（p < 0.001），右心室功能（通过三尖瓣环组织多普勒速度评估）改善了 40%（p = 0.04），而患者体重增加了 3.7%（p = 0.001）。12 例患者的纽约心脏协会（NYHA）心功能分级得到改善，而其余患者的心功能分级保持不变（p = 0.046）。8 例患者出现并发症（主要为金黄色葡萄球菌感染）。结论：PD 似乎可显著改善临床状况，这与静脉淤血和右心室收缩压改善一致，可改善老年 HF 合并 CRS 患者的临床状况。