Novel therapeutic option for refractory heart failure in elderly patients with chronic kidney disease by incremental peritoneal dialysis.

Summary: 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 ≤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. [Copyright &y& Elsevier]