Heart Failure Unit, Department of Cardiology, Hospital del Mar, 08003 Barcelona, Spain.
Department of Nephrology, Hospital del Mar, 08003 Barcelona, Spain.
Rev Cardiovasc Med. 2021 Sep 24;22(3):649-657. doi: 10.31083/j.rcm2203075.
Heart failure is a significant health problem worldwide. Despite all the new therapies available nowadays, many patients will reach advanced stages of the disease. Diuretic resistance, kidney dysfunction, and refractory congestion, all highly prevalent in advanced heart failure, frequently complicate the situation, making it more challenging to manage. Ultrafiltration through hemodialysis or peritoneal dialysis can be alternative options to treat fluid overload. Peritoneal dialysis has gained increased interest in the last decades due to several benefits such as functional class improvement, reduction in hospital admissions, improvement in quality of life, and even a reduction in mortality shown by numerous cohort studies. However, the majority of the studies were observational and with a limited number of patients. In addition, the optimal timing for the initiation of this type of therapy and the subgroup of patients who would benefit the most from it is unknown. Hence, randomized controlled trials in this subject are urgently needed. We aim to review the contemporary evidence of peritoneal dialysis in patients with heart failure and diuretic resistance across the spectrum of ventricular dysfunction and degree of renal dysfunction.
心力衰竭是全球范围内的一个重大健康问题。尽管现在有许多新的治疗方法，但许多患者仍会进入疾病的晚期。利尿剂抵抗、肾功能障碍和难治性充血，这些在晚期心力衰竭中非常普遍的情况，经常使病情复杂化，使管理更加具有挑战性。通过血液透析或腹膜透析进行超滤是治疗液体超负荷的另一种选择。由于许多队列研究显示腹膜透析具有改善心功能分级、减少住院次数、提高生活质量甚至降低死亡率等诸多益处，因此在过去几十年中，腹膜透析受到了越来越多的关注。然而，大多数研究都是观察性的，且患者数量有限。此外，这种治疗类型的最佳启动时机以及最能从中受益的患者亚组尚不清楚。因此，在这一领域急需开展随机对照试验。我们旨在回顾在不同心室功能障碍和肾功能障碍程度的心力衰竭和利尿剂抵抗患者中，腹膜透析的当代证据。
