It was decided his inclusion in PD program for CRHF with a single icodextrin exchange. At 3 months, the patient had improved their clinical condition.
Nephrology Dialysis Transplantation 30 (Supplement 3): iii537–iii555, 2015 doi:10.1093/ndt/gfv196.58
DIALYSIS. PERITONEAL DIALYSIS - 2 SP532
therapeutic response. Additionally, PD can be key to allow a more viable future for these patients allowing access to cardiac interventional therapeutic techniques and even heart transplantation, as was in our case.
PERITONEAL DIALYSIS AS A BRIDGE TO HEART TRANSPLANTATION IN PATIENTS WITH REFRACTORY HEART FAILURE
Pedro Quiros1, Cesar Remon-Rodriguez1, Jose Antonio Gómez-Puerta1 and Mercedes Tejuca1 1 Hospital Universitario Puerto Real, Nephrology, Puerto Real, Spain Introduction and Aims: Refractory chronic heart failure (CRHF) is a clinical condition characterized by resistance to standard therapy, continuous hospital admissions and poor quality of life. Peritoneal dialysis (PD) is particularly well suited to reduce edema, ascites, breathlessness and ability to undertake activities of daily living. Additional therapeutic goals would include preserving or even improving residual diuresis and diuretic sensitivity, regaining any reversibility in the functional severity of the heart failure [NYHA classification], could reduce the number of days of hospitalization and the ability to maximize pharmacological treatment of heart failure. The best solution for many of these patients would be heart transplantation (HT). However, although the absolute contraindications for HT are few, there are preconditions, such as severe pulmonary arterial hypertension (PAH), which increase morbidity or mortality and can reject the transplant indication. Our approach is that PD may be an adjuvant instrument to improve clinical condition status of patients with CRHF, to facilitate both inclusion in the HT program as its result. Methods: We analized Clinical, laboratory, functional and complementary parameters, before PD, after 3 months, and 1 month after heart trasplant: NYHA Class, Edema severity, CKD stage, Serum creatinine, eGRF (MDRD-4), Diuresis (ml/24h), SBP (mmHg), DBP (mmHg), Nº of hospital admissions for heart failure in 12 months, Diuresis (ml/24h), UF peritoneal (ml/24 h), Left Ventricular Ejection Fraction: LVEF (%) and Quality of life score (SF-36 Questionary) Results: We report the case of a male aged 47, with CRHF secondary to ischemic heart disease. Dilated cardiomyopathy and severe PAH. Very frequent hospital admissions due to congestive heart failure (NYHA class III-IV). CKD-III (Chronic Kidney Disease). It was indicated for HT, but due to multiple admissions and severe PAH it will in time delaying the surgery intervention. It was decided his inclusion in PD program for CRHF with a single icodextrin exchange. At 3 months, the patient had improved their clinical condition. NYHA class improved from Class III-VI to Class II. Average ejection fraction improved from 15-20 % to 36 %; improved diuretic response, 13 kg weight loss, no admissions for heart failure,.... At 4 months of starting PD the patient received a heart transplant, which definitely improved his clinical condition. Table 1 shows the evolution of clinical, laboratory, functional and complementary parameters from the pre-PD time to after cardiac transplantation. The peritoneal catheter was removed and currently doesn’t need UF with PD. Conclusions: The literature and the experience suggest that PD therapy is an appropiate and feasible option in the setting of CRHF and should be considered for patients in whom conventional therapies have not been associated with the desired
© The Author 2015. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.
