title: Continuous ambulatory peritoneal dialysis and clinical outcomes in patients with refractory congestive heart failure.
abstract: OBJECTIVE
  Peritoneal dialysis has been proposed as a therapeutic alternative for patients with refractory congestive heart failure. The objective of this study was to assess its effect on long-term clinical outcomes in patients with advanced heart failure and renal dysfunction.
  
  
  METHODS
  A total of 62 patients with advanced heart failure (class III/IV), renal dysfunction (glomerular filtration<60 mL/min/1.73 m(2)), persistent fluid congestion despite loop diuretic treatment and at least 2 previous hospitalizations for heart failure were invited to participate in a continuous ambulatory peritoneal dialysis program. Of these, 34 patients were excluded and adjudicated as controls. The most important reasons for exclusion were refusal to participate, inability to perform the technique and abdominal wall defects. The primary endpoint was all-cause mortality and the composite of death/readmission for heart failure. To account for baseline imbalance, a propensity score was estimated and used as a weight in all analyses.
  
  
  RESULTS
  The peritoneal dialysis (n=28) and control groups (n=34) were alike in all baseline covariates. During a median follow-up of 16 months, 39 (62.9%) died, 21 (33.9%) patients were rehospitalization for heart failure, and 42 (67.8%) experienced the composite endpoint. In the propensity score-adjusted models, peritoneal dialysis (vs control group) was associated with a substantial reduction in the risk of mortality using complete follow-up (hazard ratio=0.40; 95% confidence interval, 0.21-0.75; P=.005), mortality using days alive and out of hospital (hazard ratio=0.39; 95% confidence interval, 0.21-0.74; P=.004) and the composite endpoint (hazard ratio=0.32; 95% confidence interval, 0.17-0.61; P=.001).
  
  
  CONCLUSIONS
  In refractory congestive heart failure with concomitant renal dysfunction, peritoneal dialysis was associated with long-term improvement in clinical outcomes. Full English text available from:www.revespcardiol.org.
authors.affiliation: Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain. yulnunez@gmail.com
authors.forename: Julio
authors.initials: J
authors.lastname: Núñez
authors.forename: Miguel
authors.initials: M
authors.lastname: González
authors.forename: Gema
authors.initials: G
authors.lastname: Miñana
authors.forename: Rafael
authors.initials: R
authors.lastname: Garcia-Ramón
authors.forename: Juan
authors.initials: J
authors.lastname: Sanchis
authors.forename: Vicent
authors.initials: V
authors.lastname: Bodí
authors.forename: Eduardo
authors.initials: E
authors.lastname: Núñez
authors.forename: Maria Jesús
authors.initials: MJ
authors.lastname: Puchades
authors.forename: Patricia
authors.initials: P
authors.lastname: Palau
authors.forename: Pilar
authors.initials: P
authors.lastname: Merlos
authors.forename: Beatriz
authors.initials: B
authors.lastname: Mascarell
authors.forename: Alfonso
authors.initials: A
authors.lastname: Miguel
mesh_terms: D000368:Aged; D015331:Cohort Studies; D004351:Drug Resistance; D023381:Endpoint Determination; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D008297:Male; D010531:Peritoneal Dialysis, Continuous Ambulatory; D057216:Propensity Score; D011446:Prospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D014462:Ultrafiltration