Department of Renal Medicine, Changi General Hospital, Singapore.
Department of Nephrology and Dialysis, 220631Santa Marta e Santa Venera, Acireale, Italy.
Perit Dial Int. 2020 Nov;40(6):527-539. doi: 10.1177/0896860819895198. Epub 2020 Jan 13.
Heart failure (HF) is a major cause of morbidity and mortality. Extracorporeal (EC) therapy, including ultrafiltration (UF) and haemodialysis (HD), peritoneal dialysis (PD) and peritoneal ultrafiltration (PUF) are potential therapeutic options in diuretic-resistant states. This systematic review assessed outcomes of PD and compared the effects of PD to EC. A comprehensive search of major databases from 1966 to 2017 for studies utilising PD (or PUF) in diuretic-resistant HF was conducted, excluding studies involving patients with end-stage kidney disease. Data were extracted and combined using a random-effects model, expressed as odds ratio (OR). Thirty-one studies ( = 902) were identified from 3195 citations. None were randomised trials. Survival was variable (0-100%) with a wide follow-up duration (36 h-10 years). With follow-up > 1 year, the overall mortality was 48.3%. Only four studies compared PD with EC. Survival was 42.1% with PD and 45.0% with EC; the pooled effect did not favour either (OR 0.80; 95% confidence interval (CI): 0.24-2.69; = 0.710). Studies on PD in patients with HF reported several benefits. Left ventricular ejection fraction (LVEF) improved after PD (OR 3.76, 95%CI: 2.24-5.27; < 0.001). Seven of nine studies saw LVEF increase by > 10%. Twenty-one studies reported the New York Heart Association status and 40-100% of the patients improved by ≥ 1 grade. Nine of 10 studies reported reductions in hospitalisation frequency and/or duration. When treated with PD, HF patients had fewer symptoms, lower hospital admissions and duration compared to diuretic therapy. However, there is inadequate evidence comparing PD versus UF or HD. Further studies comparing these modalities in diuretic-resistant HF should be conducted.
心力衰竭（HF）是发病率和死亡率的主要原因。体外（EC）治疗，包括超滤（UF）和血液透析（HD）、腹膜透析（PD）和腹膜超滤（PUF），是在利尿剂抵抗状态下的潜在治疗选择。本系统评价评估了 PD 的结果，并比较了 PD 与 EC 的效果。从 1966 年到 2017 年，对利用 PD（或 PUF）治疗利尿剂抵抗性 HF 的主要数据库进行了全面检索，排除了涉及终末期肾病患者的研究。使用随机效应模型提取和合并数据，结果表示为优势比（OR）。从 3195 条引文中共确定了 31 项研究（=902）。没有随机试验。存活率各不相同（0-100%），随访时间范围很广（36 小时-10 年）。随访>1 年后，总死亡率为 48.3%。只有四项研究比较了 PD 与 EC。PD 的存活率为 42.1%，EC 为 45.0%； pooled 效应不支持任何一种（OR 0.80；95%置信区间（CI）：0.24-2.69； = 0.710）。关于 PD 在 HF 患者中的研究报告了一些益处。PD 后左心室射血分数（LVEF）改善（OR 3.76，95%CI：2.24-5.27；<0.001）。9 项研究中有 7 项 LVEF 增加超过 10%。21 项研究报告了纽约心脏协会（NYHA）状态，40-100%的患者改善了≥1 级。10 项研究中有 9 项报告了住院频率和/或持续时间减少。与利尿剂治疗相比，HF 患者接受 PD 治疗时症状更少、住院次数和时间更少。然而，目前还没有足够的证据比较 PD 与 UF 或 HD。应该进行进一步的研究比较这些方法在利尿剂抵抗性 HF 中的应用。
