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Continuous ambulatory peritoneal dialysis as a therapeutic alternative in patients with advanced congestive heart

Julio Núñez1, Miguel González, Gema Miñana

  • 1Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain. yulnunez@gmail.com

European Journal of Heart Failure
|February 14, 2012
PubMed

Insights

Continuous ambulatory peritoneal dialysis (CAPD) offers significant short-term benefits for advanced congestive heart failure (CHF) patients with renal dysfunction. This therapy improved quality of life, exercise capacity, and reduced hospitalizations for acute heart failure.

Area of Science:

  • Nephrology
  • Cardiology
  • Internal Medicine

Background:

  • Advanced congestive heart failure (CHF) often presents with renal dysfunction, complicating treatment.
  • Patients with NYHA class III/IV CHF and renal impairment experience persistent fluid overload despite diuretic therapy.
  • Frequent hospitalizations for acute heart failure (AHF) indicate a poor prognosis in this patient group.

Purpose of the Study:

  • To evaluate the therapeutic role of continuous ambulatory peritoneal dialysis (CAPD) in managing advanced CHF patients with renal dysfunction.
  • To assess the impact of CAPD on surrogate endpoints related to heart failure severity and quality of life.
  • To determine the effectiveness of CAPD in reducing AHF-related hospitalizations.

Main Methods:

  • A cohort of 25 patients with advanced CHF, renal dysfunction, and recurrent AHF hospitalizations were enrolled in a CAPD program.
  • Outcomes were assessed at 6 and 24 weeks, including the Minnesota Living With Heart Failure Questionnaire (MLWHFQ), 6-minute walk test (6MWT), and NYHA class.
  • Serum natriuretic peptides (BNP, NT-proBNP), carbohydrate antigen 125 (CA125), and AHF hospitalization rates were also monitored.

Main Results:

  • CAPD led to significant improvements in MLWHFQ scores, 6MWT distance, and NYHA functional class at both 6 and 24 weeks.
  • A marked decrease in serum CA125 levels was observed, while BNP and NT-proBNP levels remained unchanged.
  • Hospitalization rates for AHF were substantially reduced by 84% in the 6 months following CAPD initiation compared to the pre-CAPD period.

Conclusions:

  • CAPD demonstrates short-to-mid-term efficacy in improving key severity parameters for patients with advanced CHF and renal dysfunction.
  • The therapy was associated with an acceptable rate of side effects.
  • CAPD represents a viable therapeutic option for selected advanced CHF patients with concurrent renal impairment.
Abstract

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