Ultrafiltrazione peritoneale e sindrome cardiorenale: gestione del sovraccarico di fluidi e ruolo del sodio

2019 ◽  
Vol 31 (2) ◽  
pp. 100-105
Author(s):  
Luca Di Lullo ◽  
Claudio Ronco ◽  
Fulvio Floccari ◽  
Antonio De Pascalis ◽  
Rodolfo Rivera ◽  
...  
Keyword(s):  
Heart Failure ◽  
Peritoneal Dialysis ◽  
Diuretic Therapy ◽  
Decompensated Heart Failure ◽  
Cardiorenal Syndrome ◽  
Therapeutic Modality ◽  
Heart Failure Patients ◽  
Sodium Removal ◽  
Refractory Heart Failure ◽  
Home Based

Congestion represents a crucial clinical component of both heart failure and cardiorenal syndrome and it has been postulated to modulate heart and kidney cross-link. Diuretic therapy is a corner stone in the treatment patients with heart failure, and renal replacement therapies are mainly used for patients with refractory heart failure who have not reached the worst stages of renal disfunction. Peritoneal dialysis is a home-based therapeutic modality providing both solute clearance and ultrafiltration, together with relief from congestion in decompensated heart failure patients. The following review will focus on sodium removal in refractory decompensated heart failure patients undergoing peritoneal dialysis. (Cardionephrology)

scholarly journals A Single-Center Retrospective Study on the Initiation of Peritoneal Dialysis in Patients With Cardiorenal Syndrome and Subsequent Hospitalizations

2020 ◽  
Vol 7 ◽  
pp. 205435812097923
Author(s):  
Bourne L. Auguste ◽  
Arnav Agarwal ◽  
Ali Z. Ibrahim ◽  
Michael Y. Girsberger ◽  
Zita Abreu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Peritoneal Dialysis ◽  
Length Of Stay ◽  
American Literature ◽  
Diuretic Therapy ◽  
Cardiorenal Syndrome ◽  
Catheter Insertion ◽  
Health Network ◽  
Number Of Patients ◽  
Before And After

Background: Inotropic dependence and diuretic resistance in patients with cardiorenal syndrome (CRS) lead to frequent hospitalizations and are associated with high mortality. Starting peritoneal dialysis (PD) acutely (within 2 weeks of a heart failure hospitalization) offers effective volume removal without hemodynamic compromise in this population. There is little data on this approach in the North American literature. Objective: To determine whether volume-overloaded patients with CRS on maximal doses of diuretic therapy had reduced hospitalization for heart failure following PD initiation. Design: Retrospective cohort study. Setting: Academic hospital network (University Health Network, Toronto, Ontario). Patients: Patients with CRS receiving a bedside catheter and starting PD within 2 weeks of insertion at the University Health Network from January 1, 2013, to December 31, 2018. Methods and measurements: Data for heart failure–related hospitalizations and length of stay 6 months before and after PD initiation were collected. Patients who died, switched to hemodialysis, or were transferred to another facility within 6 months of starting PD were excluded from the analysis. Results: We identified 31 patients with CRS who had a bedside PD catheter inserted. The average age of patients was 66.0 ± 13.0 years. There were 7 (22.6%) deaths and 4 (12.9%) transfers to other programs or hemodialysis within 6 months of catheter insertion. After exclusion, we analyzed hospitalization and length of stay data for 20 patients. The hospitalization rate 6 months before PD initiation was 6.9 admissions per 1000 patient-days. This decreased to 2.5 admissions per 1000 patient-days after PD initiation. In addition, there was also a significant reduction in the average length of stay per hospitalization (24.1-3.9 days; P = .001). Limitations: Our study did not assess the severity of heart failure symptoms using a standardized functional classification system. We did not assess quality of life and illness intrusiveness scores before and after starting dialysis, nor did we capture non–heart-failure-related hospitalizations or external admissions at other hospital sites. We limited eligibility to clinically stable patients with no prior major abdominal surgical history in a single Canadian PD program using bedside ultrasound approach for catheter insertions by experienced nephrologists and included a small number of patients. Conclusions: Volume-overloaded patients with CRS receiving maximal diuretic therapy have lower hospitalization rates and shorter stays after initiation of PD. The development of a bedside PD catheter insertion program and close collaboration between nephrology and cardiology services may facilitate acute start dialysis in this population.

scholarly journals Nonuremic Indication for Peritoneal Dialysis for Refractory Heart Failure in Cardiorenal Syndrome Type II: Review and Perspective

2013 ◽  
Vol 33 (1) ◽  
pp. 8-14 ◽  
Author(s):  
Masaaki Nakayama
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Peritoneal Dialysis ◽  
Maintenance Therapy ◽  
Supportive Therapy ◽  
Cardiorenal Syndrome ◽  
Syndrome Type ◽  
Type Ii ◽  
Kidney Dysfunction ◽  
Refractory Heart Failure

Cardiorenal syndrome (CRS) type II is a serious condition in which chronic cardiac abnormalities cause worsening kidney function, leading to permanent chronic kidney damage. Management of CRS type II coupled with diuretic-resistant congestive heart failure (CHF) has been an issue of dispute. However, since the early 1990s, reports indicating the clinical usefulness of peritoneal dialysis (PD) as maintenance therapy for intractable CHF in this population have been accumulating. The present manuscript reviews the mechanisms by which kidney dysfunction develops within CHF, and then examines recent experiences of PD as chronic supportive therapy for intractable CRS type II, reviews the contributing mechanisms, and discusses the rationale for using PD as a new therapeutic approach in the nonuremic setting of CHF.

scholarly journals Peritoneal Dialysis Reduces the Number of Hospitalization Days in Heart Failure Patients Refractory to Diuretics

2014 ◽  
Vol 34 (1) ◽  
pp. 100-108 ◽  
Author(s):  
Cécile Courivaud ◽  
Amir Kazory ◽  
Thomas Crépin ◽  
Raymond Azar ◽  
Catherine Bresson–Vautrin ◽  
...  
Keyword(s):  
Heart Failure ◽  
Peritoneal Dialysis ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
First Year ◽  
Ventricular Ejection Fraction ◽  
Refractory Heart Failure ◽  
The Impact

BackgroundPrevious small studies have reported favorable results of peritoneal dialysis (PD) in the setting of chronic refractory heart failure (CRHF). We evaluated the impact of PD in a larger cohort of patients with CHRF where end-stage renal disease was excluded.MethodsAll patients who received PD therapy for CRHF between January 1995 and December 2010 in two medical centers in France were included in this retrospective study. Baseline characteristics were compared with clinical parameters during the first year after initiation of PD. Mortality, safety, and sustainability of PD were also analyzed.ResultsThe 126 patients included had a mean age of 72 ± 11 years and an estimated glomerular filtration rate of 33.5 ± 15.1 mL/min/1.73 m2. Mean time on PD was 16 ± 16.6 months. During the first year, patients with a left ventricular ejection fraction (LVEF) of 30% or less experienced improvement in cardiac function (30% ± 10% vs 20% ± 6%, p < 0.0001). We observed a significant reduction in the number of days of hospitalization for acute decompensated heart failure after PD initiation (3.3 ± 2.6 days/patient–month vs 0.3 ± 0.5 days/patient–month, p < 0.0001). One-year mortality was 42%.ConclusionsIn CRHF, PD significantly reduces the number of days of hospitalization for acute heart failure. Improved LVEF may have led to the comparatively good 1-year survival in this cohort.

Tidal peritoneal dialysis versus ultrafiltration in type 1 cardiorenal syndrome: A prospective randomized study

2019 ◽  
Vol 42 (12) ◽  
pp. 684-694 ◽  
Author(s):  
Abdullah K Al-Hwiesh ◽  
Ibrahiem Saeed Abdul-Rahman ◽  
Nadia Al-Audah ◽  
Amani Al-Hwiesh ◽  
Mousa Al-Harbi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Peritoneal Dialysis ◽  
Creatinine Level ◽  
Acute Decompensated Heart Failure ◽  
Therapy Group ◽  
Decompensated Heart Failure ◽  
Cardiorenal Syndrome ◽  
Fluid Loss ◽  
Tidal Peritoneal Dialysis

Background: Ultrafiltration is an alternative strategy to diuretic therapy for the treatment of patients with acute decompensated heart failure. Little is known about the efficacy and safety of peritoneal dialysis in patients with acute decompensated heart failure complicated by acute cardiorenal syndrome. Methods: We randomly assigned a total of 88 patients with type 1 acute cardiorenal syndrome to a strategy of ultrafiltration therapy (44 patients) or tidal peritoneal dialysis (44 patients). The primary endpoint was the change from baseline in the serum creatinine level and left ventricular function represented as ejection fraction, as assessed 72 and 120 h after random assignment. Patients were followed for 90 days after discharge from the hospital. Results: Ultrafiltration therapy was inferior to tidal peritoneal dialysis therapy with respect to the primary endpoint of the change in the serum creatinine levels at 72 and 120 h ( p = 0.041) and ejection fraction at 72 and 120 h after enrollment ( p = 0.044 and p = 0.032), owing to both an increase in the creatinine level in the ultrafiltration therapy group and a decrease in its level in the tidal peritoneal dialysis group. At 120 h, the mean change in the creatinine level was 1.4 ± 0.5 mg/dL in the ultrafiltration therapy group, as compared with 2.4 ± 1.3 mg/dL in the tidal peritoneal dialysis group ( p = 0.023). At 72 and 120 h, there was a significant difference in weight loss between patients in the ultrafiltration therapy group and those in the tidal peritoneal dialysis group ( p = 0.025). Net fluid loss was also greater in tidal peritoneal dialysis patients ( p = 0.018). Adverse events were more observed in the ultrafiltration therapy group ( p = 0.007). At 90 days post-discharge, tidal peritoneal dialysis patients had fewer rehospitalization for heart failure (14.3% vs 32.5%, p = 0.022). Conclusion: Tidal peritoneal dialysis is a safe and effective means for removing toxins and large quantities of excess fluid from patients with intractable heart failure. In patients with cardiorenal syndrome type 1, the use of tidal peritoneal dialysis was superior to ultrafiltration therapy for the preservation of renal function, improvement of cardiac function, and net fluid loss. Ultrafiltration therapy was associated with a higher rate of adverse events.

scholarly journals Extracorporeal Ultrafiltration for Acute Heart Failure: Lost Battle or Lasting Opportunity?

2016 ◽  
Vol 43 (1-3) ◽  
pp. 1-10 ◽  
Author(s):  
Abhilash Koratala ◽  
Amir Kazory
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Decompensated Heart Failure ◽  
Cardiorenal Syndrome ◽  
Prognostic Impact ◽  
Efficacy And Safety ◽  
Fluid Removal ◽  
Beneficial Effects ◽  
Sodium Removal

The negative prognostic impact of congestion and worsening renal function in patients with decompensated heart failure (HF) has been widely recognized. As diuretics are thought to provide suboptimal results and are associated with a number of adverse effects, a number of diuretic-sparing therapeutic strategies have been explored. Extracorporeal ultrafiltration (UF) represents an intriguing option that presumably lacks many of the untoward effects of diuretic-based regimens while portending several advantages. However, conflicting data have recently emerged in relation to some of its previously proposed beneficial effects possibly due to counterbalance of the underexplored mechanisms. Herein, the existing literature on the role of UF therapy for management of acute decompensated HF is briefly reviewed with special emphasis on its impact on surrogates of efficacy and safety such as excess fluid removal and renal function. A number of topics relevant to cardiorenal syndrome such as congestion and sodium removal are also discussed.

Diuretic response and effects of diuretic omission in ambulatory heart failure patients on chronic low‐dose loop diuretic therapy

2021 ◽  
Author(s):  
Jeroen Dauw ◽  
Pieter Martens ◽  
Gregorio Tersalvi ◽  
Joren Schouteden ◽  
Sébastien Deferm ◽  
...  
Keyword(s):  
Heart Failure ◽  
Low Dose ◽  
Loop Diuretic ◽  
Diuretic Therapy ◽  
Heart Failure Patients ◽  
Diuretic Response
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