Continuous ambulatory peritoneal dialysis as a therapeutic alternative in patients with advanced congestive heart failure.
OBJECTIVE
Continuous ambulatory peritoneal dialysis (CAPD) has been proposed as an additional therapeutic resource for patients with advanced congestive heart failure (CHF). The objective of this study was to determine the therapeutic role of CAPD, in terms of surrogate endpoints, in the management of patients with advanced CHF and renal dysfunction.


RESULTS
A total of 57 candidates with New York Heart Association (NYHA) class III/IV CHF, renal dysfunction (glomerular filtration rate < 60 mL/min/1.73 m(2)), persistent fluid congestion despite loop diuretic treatment, and at least two previous hospitalizations for acute heart failure (AHF) were invited to be included in the CAPD programme; however, 25 patients were finally included. The primary outcome was evaluated by the change at 6 and 24 weeks for the Minnesota Living With Heart Failure Questionnaire (MLWHFQ), the 6 min walk test (6MWT), NYHA class, serum natriuretic peptides [brain natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP)], serum carbohydrate antigen 125 (CA125), and hospitalization rates for AHF. CAPD was associated with a substantial improvement in the MLWHFQ (-21.3, P < 0.001; and -20.4, P < 0.001), the 6MWT (54.0, P < 0.001; and 45.6, P = 0.023), and NYHA class (-1.0, P < 0.001; and -1.4, P < 0.001) at 6 and 24 weeks, respectively. The Ln(CA125) decreased markedly (-0.8, P = 0.003; and -0.98, P = 0.003), with no effect on BNP and NT-proBNP. There was a marked reduction in the number of days hospitalized for AHF (6 month post-CAPD vs. 6 months pre-CAPD: -84%; P < 0.001).


CONCLUSIONS
In advanced CHF and renal dysfunction, CAPD was associated with short/mid-term improvement in severity parameters, with an acceptable rate of side effects.
Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain. yulnunez@gmail.com
Julio
J
Núñez
Miguel
M
González
Gema
G
Miñana
Rafael
R
Garcia-Ramón
Juan
J
Sanchis
Vicent
V
Bodí
Eduardo
E
Núñez
Maria Jesús
MJ
Puchades
Patricia
P
Palau
Pilar
P
Merlos
Angel
A
Llàcer
Alfonso
A
Miguel
D000553:Ambulatory Care / Q000379:methods*; D015415:Biomarkers / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000379:methods*; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000150:complications / Q000628:therapy*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
D015415:Biomarkers