Institute of Nephrology and Hypertension, Sheba Medical Center and Sackler Faculty of Medicine, Tel-Hashomer, Israel.
Leviev Heart Center, Sheba Medical Center and Sackler Faculty of Medicine, Tel-Hashomer, Israel.
Int J Clin Pract. 2021 Mar;75(3):e13727. doi: 10.1111/ijcp.13727. Epub 2020 Nov 1.
Peritoneal dialysis (PD) is increasingly used for the long-term management of hypervolemic refractory congestive heart failure (CHF) patients, in particular when complicated by renal insufficiency. While PD has many advantages over hemodialysis (HD) in those patients, there is a controversy concerning survival superiority of PD compared with HD in this population. The aim of the study was to define typical patient profile and to compare outcomes of patients with CHF and renal failure treated with HD or PD.
This retrospective cohort study enrolled CHF patients treated with chronic PD or HD between the years 2009-2018. Information at dialysis initiation included age, gender, body weight, blood pressure, cause of renal disease, comorbidities, hospitalisations, echocardiographic and laboratory parameters. Survival was compared between PD and HD patients using a Kaplan-Meier model and Cox regression analysis.
CHF patients treated with PD had significantly higher eGFR and lower systolic blood pressure compared with HD treated patients. Median survival time was 13.32 (7.08, 23.28) months in the PD group and 19.68 (9.48, 39.24) months in the HD group, P = .013. After adjustment for confounders the mortality risk amongst PD and HD patients was not significantly different: adjusted HR for death in PD vs HD patients was 1.44, P = .35 for 1- year and 1.69, P = .10 for 2-year mortality. Number of hospitalisations was similar in both groups.
CHF patient profile was different in PD and HD. Two modalities were equally effective in the treatment of patients with CHF and renal failure considering different patient characteristics.
腹膜透析（PD）越来越多地用于治疗高血容量难治性充血性心力衰竭（CHF）患者，尤其是合并肾功能不全的患者。虽然 PD 在这些患者中比血液透析（HD）有许多优势，但 PD 与 HD 相比在该人群中的生存优势仍存在争议。本研究的目的是确定典型患者特征，并比较接受 HD 或 PD 治疗的 CHF 和肾衰竭患者的结局。
本回顾性队列研究纳入了 2009 年至 2018 年间接受慢性 PD 或 HD 治疗的 CHF 患者。透析开始时的信息包括年龄、性别、体重、血压、病因、合并症、住院情况、超声心动图和实验室参数。采用 Kaplan-Meier 模型和 Cox 回归分析比较 PD 和 HD 患者的生存情况。
与 HD 治疗的患者相比，接受 PD 治疗的 CHF 患者的 eGFR 更高，收缩压更低。PD 组的中位生存时间为 13.32（7.08，23.28）个月，HD 组为 19.68（9.48，39.24）个月，P ＝.013。调整混杂因素后，PD 和 HD 患者的死亡率无显著差异：PD 与 HD 患者 1 年和 2 年死亡率的调整 HR 分别为 1.44，P ＝.35 和 1.69，P ＝.10。两组的住院次数相似。
PD 和 HD 患者的 CHF 患者特征不同。考虑到不同的患者特征，两种治疗方式在治疗 CHF 合并肾衰竭患者方面同样有效。
