Congestive heart failure treated with peritoneal dialysis or hemodialysis: Typical patient profile and outcomes in real-world setting.
Journal
International journal of clinical practice
ISSN: 1742-1241
Titre abrégé: Int J Clin Pract
Pays: India
ID NLM: 9712381
Informations de publication
Date de publication:
Mar 2021
Mar 2021
Historique:
revised:
26
08
2020
received:
29
05
2020
accepted:
11
09
2020
pubmed:
23
9
2020
medline:
12
5
2021
entrez:
22
9
2020
Statut:
ppublish
Résumé
Peritoneal dialysis (PD) is increasingly used for the long-term management of hypervolemic refractory congestive heart failure (CHF) patients, in particular when complicated by renal insufficiency. While PD has many advantages over hemodialysis (HD) in those patients, there is a controversy concerning survival superiority of PD compared with HD in this population. The aim of the study was to define typical patient profile and to compare outcomes of patients with CHF and renal failure treated with HD or PD. This retrospective cohort study enrolled CHF patients treated with chronic PD or HD between the years 2009-2018. Information at dialysis initiation included age, gender, body weight, blood pressure, cause of renal disease, comorbidities, hospitalisations, echocardiographic and laboratory parameters. Survival was compared between PD and HD patients using a Kaplan-Meier model and Cox regression analysis. CHF patients treated with PD had significantly higher eGFR and lower systolic blood pressure compared with HD treated patients. Median survival time was 13.32 (7.08, 23.28) months in the PD group and 19.68 (9.48, 39.24) months in the HD group, P = .013. After adjustment for confounders the mortality risk amongst PD and HD patients was not significantly different: adjusted HR for death in PD vs HD patients was 1.44, P = .35 for 1- year and 1.69, P = .10 for 2-year mortality. Number of hospitalisations was similar in both groups. CHF patient profile was different in PD and HD. Two modalities were equally effective in the treatment of patients with CHF and renal failure considering different patient characteristics.
Sections du résumé
BACKGROUND
BACKGROUND
Peritoneal dialysis (PD) is increasingly used for the long-term management of hypervolemic refractory congestive heart failure (CHF) patients, in particular when complicated by renal insufficiency. While PD has many advantages over hemodialysis (HD) in those patients, there is a controversy concerning survival superiority of PD compared with HD in this population. The aim of the study was to define typical patient profile and to compare outcomes of patients with CHF and renal failure treated with HD or PD.
METHODS
METHODS
This retrospective cohort study enrolled CHF patients treated with chronic PD or HD between the years 2009-2018. Information at dialysis initiation included age, gender, body weight, blood pressure, cause of renal disease, comorbidities, hospitalisations, echocardiographic and laboratory parameters. Survival was compared between PD and HD patients using a Kaplan-Meier model and Cox regression analysis.
RESULTS
RESULTS
CHF patients treated with PD had significantly higher eGFR and lower systolic blood pressure compared with HD treated patients. Median survival time was 13.32 (7.08, 23.28) months in the PD group and 19.68 (9.48, 39.24) months in the HD group, P = .013. After adjustment for confounders the mortality risk amongst PD and HD patients was not significantly different: adjusted HR for death in PD vs HD patients was 1.44, P = .35 for 1- year and 1.69, P = .10 for 2-year mortality. Number of hospitalisations was similar in both groups.
CONCLUSIONS
CONCLUSIONS
CHF patient profile was different in PD and HD. Two modalities were equally effective in the treatment of patients with CHF and renal failure considering different patient characteristics.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e13727Informations de copyright
© 2020 John Wiley & Sons Ltd.
Références
Couchoud C, Lassalle M, Stengel B, Jacquelinet C. Renal epidemiology and information network: 2007 annual report. Nephrol Ther. 2009;5(Suppl 1):S3-S144.
US Renal Data System, USRDS 2009 Annual Data Report. Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases: Bethesda, MD, 2009.
Nakayama M. Nonuremic indication for peritoneal dialysis for refractory heart failure in cardiorenal syndrome type II: review and perspective. Perit Dial Int. 2013;33(1):8-14.
Ross EA, Kazory A. Ultrafiltration therapy for cardiorenal syndrome: physiologic basis and contemporary options. Blood Purif. 2012;34(2):149-157.
Kunin M, Carmon V, Arad M, et al. Inflammatory biomarkers in refractory congestive heart failure patients treated with peritoneal dialysis. Biomed Res Int. 2015;2015:590851. https://doi.org/10.1155/2015/590851
Cnossen TT, Kooman JP, Konings CJAM, Uszko-Lencer NHMK, Leunissen KML, van der Sande FM. Peritoneal dialysis in patients with primary cardiac failure complicated by renal failure. Blood Purif. 2010;30:146-152.
Sanchez JE, Ortega T, Rodriguez C, et al. Efficacy of peritoneal ultrafiltration in the treatment of refractory congestive heart failure. Nephrol Dial Transplant. 2010;25:605-610.
Sotirakopoulos NG, Kalogiannidou IM, Tersi ME, Mavromatidis KS. Peritoneal dialysis for patients suffering from severe heart failure. Clin Nephrol. 2011;76:124-129.
Kunin M, Arad M, Dinour D, Freimark D, Holtzman EJ. Peritoneal dialysis in patients with refractory congestive heart failure: potential prognostic factors. Blood Purif. 2013;35:285-294.
Couchoud C, Savoye E, Frimat L, Ryckelynck JP, Chalem Y, Verger C. Variability in case mix and peritoneal dialysis selection in fifty-nine French districts. Perit Dial Int. 2008;28:509-517.
Sens F, Schott-Pethelaz AM, Labeeuw M, Colin C, Villar E. Survival advantage of hemodialysis relative to peritoneal dialysis in patients with end-stage renal disease and congestive heart failure. Kidney Int. 2011;80(9):970-977.
Stack AG, Molony DA, Rahman NS, Dosekun A, Murthy B. Impact of dialysis modality on survival of new ESRD patients with congestive heart failure in the United States. Kidney Int. 2003;64:1071-1079.
Wang IK, Kung PT, Kuo WY, et al. Impact of dialysis modality on the survival of end stage renal disease patients with or without cardiovascular disease. J Nephrol. 2013;26:331-341.
Senni M, Tribouilloy CM, Rodeheffer RJ, et al. Congestive heart failure in the community: a study of all incident cases in Olmsted County, Minnesota, in 1991. Circulation. 1998;98(21):2282-2289.
Panday VB, Tong ZP, Ng PL, et al. Dialysis modality and 2-year outcomes in patients with ischemic cardiomyopathy and end-stage renal disease. Int J Cardiol. 2014;176(3):1097-1099.
Horwich TB, Kalantar-Zadeh K, MacLellan RW, Fonarow GC. Albumin levels predict survival in patients with systolic heart failure. Am Heart J. 2008;155(5):883.
Block GA, Klassen PS, Lazarus JM, Ofsthun N, Lowrie EG, Chertow GM. Mineral metabolism, mortality, and morbidity in maintenance hemodialysis. J Am Soc Nephrol. 2004;15(8):2208.
Slinin Y, Foley RN, Collins AJ. Calcium, phosphorus, parathyroid hormone, and cardiovascular disease in hemodialysis patients: the USRDS waves 1, 3, and 4 study. J Am Soc Nephrol. 2005;16(6):1788.
Allen LA, Felker GM, Pocock S, et al. Liver function abnormalities and outcome in patients with chronic heart failure: data from the Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity (CHARM) program. Eur J Heart Fail. 2009;11(2):170.
Korevaar GW, Feith FWD, van Manen JG, et al. NECOSAD Study Group. Effect of starting with hemodialysis compared with peritoneal dialysis in patients new on dialysis treatment: a randomized controlled trial. Kidney Int. 2003;64:2222-2228.