Abstract
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. 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. During follow-up (median, 26.5 months), PD was well tolerated by all patients, and no patients required hospitalization for HF. Three ...Continue Reading
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