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Novel therapeutic option for refractory heart failure in elderly patients with chronic kidney disease by incremental
Masaru Nakayama1, Hirofumi Nakano, Masaaki Nakayama
1Division of Cardiology, Kashima Hospital, 22-1 Kashimamachi, Shimokuramochi, Aza-Nakasawame, Iwaki, Fukushima 971-8143, Japan. ms-nakayama@kashima.jp
Insights
Incremental peritoneal dialysis (PD) offers a promising treatment for elderly patients with chronic kidney disease (CKD) and heart failure (HF). This novel approach improved heart function and reduced hospitalizations without adverse events.
Area of Science:
- Nephrology
- Cardiology
- Geriatrics
Background:
- Heart failure (HF) and chronic kidney disease (CKD) frequently coexist in elderly individuals, creating a complex clinical challenge.
- Aggressive diuretic therapy in this population can exacerbate cardio-renal deterioration, leading to increased hospitalizations and mortality.
- Peritoneal dialysis (PD) offers continuous fluid removal, presenting a potential alternative for managing refractory HF in CKD patients.
Purpose of the Study:
- To evaluate the clinical feasibility and therapeutic effects of a novel incremental peritoneal dialysis (PD) regimen.
- To assess the impact of PD on elderly patients suffering from chronic kidney disease (CKD) and refractory heart failure (HF).
Main Methods:
- Twelve elderly CKD patients (stages 3-5) with NYHA class III/IV refractory HF underwent incremental PD.
- Treatment involved initial sequential hemofiltration followed by 3 PD sessions/week, with adjustments in frequency and duration based on clinical need.
- Patients had a history of frequent hospitalizations (>3 in the prior year) due to HF.
Main Results:
- Peritoneal dialysis (PD) was well-tolerated, with no HF-related hospitalizations during a median follow-up of 26.5 months.
- Significant improvements were observed in NYHA functional class (I/II), reduced diuretic dosage, and stabilized kidney function.
- Key positive outcomes included a 5% decrease in left ventricular end-diastolic diameter and a 15% increase in hemoglobin levels.
Conclusions:
- Incremental PD presents a viable therapeutic option for elderly patients with refractory heart failure (HF) and chronic kidney disease (CKD).
- Benefits may stem from fluid removal, correction of renal anemia, kidney function preservation, and avoidance of high-dose diuretics.
- This approach may help mitigate cardio-renal deterioration and improve patient outcomes.
Background:
Heart failure (HF) often accompanies chronic kidney disease (CKD) in the elderly. This clinical condition is a critical socio-medical issue, because high-dose diuretic therapy stimulates the renin-angiotensin-aldosterone axis and sympathetic nervous system outflow, and may thus result in vicious cycles of cardio-renal deterioration, leading to excess hospitalization and death. Peritoneal dialysis (PD) is a renal replacement therapy used for maintenance dialysis, and is characterized by the continuous removal of fluid. The present study examined the clinical feasibility and effects of a novel style of PD for elderly CKD patients with refractory HF.
Methods:
Twelve elderly CKD patients (stages 3-5) with refractory HF [New York Heart Association (NYHA) class III, n=9; IV, n=3; mean age, 81+/-6 years] received PD treatment. Patients had episodes of >3 hospitalizations in the previous year, and were initially treated with < or =19 sessions of sequential hemofiltration, followed by incremental PD, with 3 PD sessions/week (8h each) at the start, increasing in frequency and dwelling time as clinically indicated.
Results:
During follow-up (median, 26.5 months), PD was well tolerated by all patients, and no patients required hospitalization for HF. Three patients died due to non-HF-related events. All patients showed improvements in NYHA functional class (class I, n=9; class II, n=3) and significant decreases in the dose of diuretics prescribed (P<0.05). Kidney function stabilized, while significant improvements in end-diastolic left ventricular diameter (-5%, P<0.05) and hemoglobin count (+15%, P<0.05) were achieved. Brain natriuretic peptide (-46%) and aldosterone (-13%) levels tended to decrease.
Conclusions:
Incremental PD could represent a novel therapeutic option for elderly patients with refractory HF. In addition to fluid removal by PD, correction of renal anemia, preservation of kidney function, and avoidance of high-dose diuretic therapy may play a role in maximizing clinical benefits.
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