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Long-Term Impact of Peritoneal Dialysis Ultrafiltration on Cardiorenal Patients
Sara Núñez-Delgado1, Maria Antonieta Azancot1, Ana Belén Méndez Fernandez2
1Nephrology Department, Vall d'Hebron University Hospital, Nephrology and Transplantation group, Vall d'Hebron Research Institute, Barcelona, Spain.
Insights
Peritoneal dialysis for ultrafiltration (PD-UF) is a viable treatment for advanced heart failure (HF) and cardiorenal syndrome (CRS). Patient outcomes are influenced by age, frailty, and cardiac disease burden.
Area of Science:
- Nephrology
- Cardiology
- Renal Replacement Therapy
Background:
- Increasing prevalence of heart failure (HF) and its comorbidities, such as cardiorenal syndrome (CRS).
- CRS is characterized by diuretic resistance or kidney deterioration, impacting HF prognosis.
- Peritoneal dialysis for ultrafiltration (PD-UF) is a potential but understudied treatment for CRS.
Purpose of the Study:
- To evaluate the long-term outcomes of PD-UF in patients with advanced heart failure and cardiorenal syndrome.
- To identify factors associated with patient and technique survival in this complex patient population.
Main Methods:
- Retrospective registry study using the Catalan Renal Registry (2013-2022).
- Inclusion of patients with an indication for PD-UF.
- Analysis of baseline clinical characteristics and follow-up data until December 2022.
Main Results:
- 198 patients (10.6%) initiated PD-UF; mean age 70.7 years, predominantly male (73.2%).
- Median eGFR at start was 22.6 mL/min×1.73 m2; 75% had eGFR > 15 mL/min×1.73 m2.
- Significant comorbidities including ischemic heart disease, arrhythmia, and cardiac surgery were common.
- Median overall patient survival was 21 months; 1-year technique survival was 94.8%.
- Factors associated with poor survival included older age (≥75 years), frailty, and cardiac disease burden.
- Lower eGFR (<30 mL/min×1.73 m2) and low BMI (<20 kg/m2) were linked to technique survival.
Conclusions:
- PD-UF is a feasible ultrafiltration strategy for patients with advanced HF and CRS.
- Older age, frailty, and a higher burden of cardiac disease complicate management and impact survival.
- Careful patient selection and monitoring are crucial for optimizing PD-UF outcomes in this population.
Background:
Heart failure (HF) prevalence is increasing, and its prognosis worsens in the presence of other comorbidities. Up to 70% of patients develop cardiorenal syndrome (CRS), which is associated with diuretic resistance or kidney deterioration over time. Peritoneal dialysis (PD) for ultrafiltration (PD-UF) could be a potential therapeutic option in CRS, although its long-term outcomes have not been described.
Methods:
Retrospective registry study of the Catalan Renal Registry on patients with PD-UF indication between 2013 and 2022. Baseline clinical characteristics and follow-up until December/2022 was studied.
Results:
Of the 1,874 incident patients on PD, 198 (10.6%) were PD-UF, 73.2% of the patients were male, and the mean age was 70.7 ± 9.3 years. Median estimated glomerular filtration rate (eGFR) at start was 22.6 (IQR: 14.8-32.8) mL/min×1.73 m2 and 75.0% have an eGFR above 15 mL/min×1.73 m2. Previous history of ischemic heart disease, arrhythmia, or cardiac surgery was recorded, and 57.6% of patients had ≥2 of these pathologies. The most common HF etiology was ischemic heart disease in 21.7% of patients. Median overall patient survival was 21 (IQR: 17.3-24.3) months. Technique survival at 1 year was 94.8%, and 27 patients were transferred to other renal replacement therapy (hemodialysis or kidney transplantation). In the Cox multivariate analysis, age ≥75 years (HR: 1.76 [95% CI: 1.20-2.59]), mild frailty (HR: 2.18 [95% CI: 1.17-2.59]), severe frailty (HR: 17.62 [95% CI: 1.20-55.48]), and the burden of cardiac disease (2 categories HR: 2.17 [95% CI: 1.05-4.47]; 3 categories HR: 2.26 [95% CI: 1.05-4.89]) were associated with poor overall survival. Technique survival was associated with eGFR (<30 mL/min×1.73 m2 HR: 5.64 [95% CI: 1.32-24.18]) and body mass index (<20 kg/m2 HR: 6.53 [95% CI: 1.06-40.12]) at baseline.
Conclusion:
PD-UF is a feasible option in patients with advanced HF and CRS. The complexity of this population increases with older age, frailty, and higher cardiac burden.
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