Abstract

SANCHEZ, Emilio et al. Role of peritoneal dialysis in the treatment of heart failure. Insuf. card. [online]. 2010, vol.5, n.3, pp.105-112. ISSN 1852-3862.

Background. Heart failure (HF) is a progressive disorder even with adequate treatment. Fluid removal may aid in the management of these patients. We evaluated the efficacy of peritoneal dialysis (PD) in the treatment of refractory HF. Patients and methods. Prospective, non-randomized study involving patients with congestive HF refractory to maximum tolerable drug treatment. All of them were treated with PD. We analysed clinical data and functional status. To determine efficacy we compared the perceived state of health to PD patients respect to those reported with conservative therapies. Finally, we carried out a cost-utility evaluation. Results. Twenty-five patients (68% men, 66±10 years) were included and 16 were still undergoing PD at the end of the follow-up period (20±9 months). Twenty-one patients underwent only one daily nocturnal exchange; the rest, 2 or 3 exchanges due to different degrees of renal failure. All of them improved their NYHA functional status, (4% three classes, 64% two, 32% one; P<0.001), with a reduction in their pulmonary artery systolic pressure (46±12 vs 25±9 mm Hg; P=0.007). Hospitalization rates underwent a dramatic reduction (from 65±16 to 9±5 days/patient/year; P=0.002). PD life expectancy was 84% after 12 months of treatment, and 72% and 58% after 18 and 24 months. PD was associated with a higher perception state of health than the conservative therapy, (0.6978 vs 0.4104; P<0.01). PD is cost-effective compared with the diuretic regimens. Conclusions. PD is a good option for patients with refractory HF; it improves the functional status and quality of life, reduces morbidity, mortality and health care costs.

Keywords : Heart failure; Peritoneal dialysis; Diuretics; Ultrafiltration; Quality of life; Cost-utility.

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