title: Peritoneal dialysis in patients with refractory congestive heart failure: potential prognostic factors.
abstract: BACKGROUND
  Peritoneal dialysis (PD) is increasingly used for long-term management of refractory congestive heart failure (CHF). In this study, we investigated the outcome of patients with refractory CHF treated with PD, aiming to identify potential prognostic factors for long term-survival.
  
  
  METHODS
  This was a prospective observational study over a period of 42 months which included 37 refractory CHF patients.
  
  
  RESULTS
  Median survival on PD was 14 months (1-41 months). Long survivors had serum sodium >132 mEq/l (p < 0.001), serum albumin >3.2 g/dl (p < 0.001) and hospitalization rate <2 days per month a year before starting the treatment (p = 0.008). Patients in the lowest survival quartile had lower serum albumin (2.8 vs. 3.5 g/dl in longer survivors, p = 0.003) and serum sodium (126 vs. 137 mEq/l, p < 0.0001), higher serum leukocyte count (7,500 vs. 6,800/μl in long survivors, p = 0.033), higher glomerular filtration rate (39.4 vs. 29.9 ml/min/1.73 m(2), p = 0.035), had more hospitalization before starting the treatment (3.4 vs. 1.9 days per month, p = 0.003) and lower estimated left ventricular mass index (113 vs. 137 g/m(2), p = 0.035). Long-term survivors demonstrated significant improvement in the New York Heart Association functional class by a median of one class, reduced hospitalization rate by 55% and decrease in dependence on intravenous diuretics and vasoactive medications (73% drop in CHF day care visits during the first year of treatment).
  
  
  CONCLUSIONS
  Survival of patients with refractory CHF treated with PD is highly variable. Serum sodium, serum albumin and hospitalization rate are important prognostic factors for long-term survival. Long survivors demonstrated improved functional status, reduced hospitalization and mortality rates.
authors.affiliation: Nephrology and Hypertension Institute, Sheba Medical Center and Sackler Faculty of Medicine, Tel-Hashomer, Israel. Margarita.Kunin@sheba.health.gov.il
authors.forename: Margarita
authors.initials: M
authors.lastname: Kunin
authors.forename: Michael
authors.initials: M
authors.lastname: Arad
authors.forename: Dganit
authors.initials: D
authors.lastname: Dinour
authors.forename: Dov
authors.initials: D
authors.lastname: Freimark
authors.forename: Eli J
authors.initials: EJ
authors.lastname: Holtzman
mesh_terms: D000368:Aged; D018572:Disease-Free Survival; D004232:Diuretics / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006333:Heart Failure / Q000097:blood / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D008297:Male; D010530:Peritoneal Dialysis; D012189:Retrospective Studies; D012964:Sodium / Q000097:blood; D015996:Survival Rate; D014662:Vasoconstrictor Agents / Q000008:administration & dosage
chemical_list: D004232:Diuretics; D014662:Vasoconstrictor Agents; D012964:Sodium