title: Peritoneal dialysis for patients suffering from severe heart failure.
abstract: Over a period of 6.5 years, we treated 19 patients, all of whom suffered from severe heart failure and various stages of chronic kidney disease, excluding those with end-stage kidney failure. Before peritoneal catheter implantation, all patients had ascites, dyspnea, orthopnea, and an ejection fraction ranging from 20 to 45%. Seven of them (7/19) were able to take care of themselves, 9/19 needed assistance for their daily activities, and the remaining 3 were bedridden. All of them needed hospitalization 1 - 3 times/month during the year before the initiation of continuous ambulatory peritoneal dialysis (CAPD). With peritoneal dialysis, daily ultrafiltrate volume ranged from 500 to 3,000 ml and, after an average of 2 months of peritoneal dialysis, body weight decreased significantly (74.7 ± 13 vs. 69.7 ± 10.2, p = 0.02). At the same time, diuresis improved significantly, and this allowed a reduction in the dose of diuretics. Dyspnea and orthopnea improved significantly in all patients. The patients' degree of self-care and ability to sleep lying flat improved significantly as the need for hospitalization declined. Before peritoneal dialysis, patients were hospitalized for 5 - 20 days/month for pulmonary edema or overhydration, whereas with peritoneal dialysis, nobody was hospitalized for these causes (chi2, p = 0.0001). Ejection fraction also improved in all of them (28.6 ± 8.6 vs. 36.8 ± 12.5%, p = 0.0001). Actual survival of our patients ranged from 6 to 86 months (mean ± SD = 24.6 ± 20.8). Actuarial survival was 68% at 1 year and 42% at 2 years. During peritoneal dialysis we observed only two episodes of peritonitis. Four patients developed a severe episode of hypotension during implantation of the catheters from the sudden removal of 4 - 6 l of ascitic fluid. We conclude that peritoneal dialysis is a good method for the treatment of congestive heart failure because it increases the quality of life and life expectancy in patients with poor prognosis.
authors.affiliation: Renal Department of General Hospital of Komotini, Komotini, Greece.
authors.forename: N G
authors.initials: NG
authors.lastname: Sotirakopoulos
authors.forename: I M
authors.initials: IM
authors.lastname: Kalogiannidou
authors.forename: M E
authors.initials: ME
authors.lastname: Tersi
authors.forename: K S
authors.initials: KS
authors.lastname: Mavromatidis
mesh_terms: D000206:Actuarial Analysis; D000368:Aged; D000369:Aged, 80 and over; D005936:Glucans; D005947:Glucose; D006333:Heart Failure / Q000150:complications / Q000628:therapy*; D015312:Hemodialysis Solutions; D006801:Humans; D000077607:Icodextrin; D008875:Middle Aged; D010531:Peritoneal Dialysis, Continuous Ambulatory; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000628:therapy*; D013318:Stroke Volume; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D005936:Glucans; D015312:Hemodialysis Solutions; D000077607:Icodextrin; D005947:Glucose