The impact of peritoneal dialysis upon quality of life and mortality of patients with end-stage congestive heart failure.
BACKGROUND
Aged patients affected by congestive heart failure refractory to pharmacologic therapy, coupled with severe comorbidities that preclude heart transplantation have a gloomy prognosis. Use of automated peritoneal dialysis resulted in a significantly improved quality of life and survival.


METHODS
Twenty patients (mean age: 65.7 +/- 7.7 years) with severe congestive heart failure (Class IV-NYHA) and a high Charlson comorbidity index (7.8 +/- 1.8) were treated by means of automated peritoneal dialysis (3 sessions/week, 8 h each). The period of follow-up ranged between 7 and 35 months (19.8 +/- 7.4 months).


RESULTS
After 1 year of follow-up, all patients showed functional (Class I-NYHA) and hemodynamic improvement: left cardiac work index increased from 2.33 +/- 0.69 to 2.59 +/- 0.47 kg/min/m(2) (p < 0.01); systolic times ratio was significantly reduced (from 61.14 +/- 12.57 to 39.18 +/- 13.44%, p < 0.01); and the thoracic fluid contents was substantially reduced (from 0.04 +/- 0.005 to 0.003 +/- 0.0001 Omega). A marked drop of hospitalization days was observed.


CONCLUSIONS
Automated peritoneal dialysis appears as a promising tool for treating patients suffering from refractory, end stage congestive heart failure. Improvement of cardiac function may result from clearing the blood from middle molecular weight myocardial depressant substances, including atrial natriuretic peptide. Results of this investigation are a call for a prospective multicenter study in order to confirm these promising observations.
Gotloib
Lazaro
L
Department of Nephrology, Ha'Emek Medical Center, Afula, Israel.
Fudin
Roberto
R
D000368:Aged; D006333:Heart Failure / Q000401:mortality / Q000523:psychology / Q000628:therapy*; D006801:Humans; D008875:Middle Aged; D010530:Peritoneal Dialysis; D011788:Quality of Life