SP511PERITONEAL DIALYSIS IN PATIENTS WITH REFRACTORY HEART FAILURE AND OVERHYDRATION

Abstract

INTRODUCTION AND AIMS: The aim of this study was to evaluate the efficacy of peritoneal dialysis (PD) in the treatment of refractory Heart Failure (HF) in terms of weight loss, hospitalizations, cardiac functional status and technique complications. METHODS: From December 2014 to December 2016, we conducted a prospective non-randomized study involving patients with NYHA class IV HF with no previous chronic kidney disease (eGFR>60ml/min), who were refractory to maximum treatment with diuretics (loop diuretics, thiazides and MR inhibitors), beta blockers and cardiac resynchronization therapy where appropriate. Routine biochemical parameters were monitored before the initiation of the study and after 1, 3 and 6 months of PD treatment. An echocardiogram was performed at baseline and after 6 months. Side effects related to PD were also recorded. Following parameters were monitored: weight, 24h diuresis, peritoneal Ultrafiltration (PUF), glomerular filtration rate, LVEF, total hospitalization days due to overhydration before and after PD treatment and mortality. RESULTS: PD treatment was performed in six patients (3 men) with a mean age of 67,8 ± 13 years. Follow up period was 12,5 ± 8 months. During that period two patients died at 13 and 17 months after PD initiation. All patients improved their NYHA score (p=0,002) with no alterations in LVEF. eGFR showed a non significant decrease during the 6 month observational period while serum urea was decreased. Body weight was significantly decreased one month after initiation of PD (79,3±19 vs. 75,2±20 kg, p<0,001) and showed a non marked increase thereafter due to increased calories consumption. Diuresis was transiently increased one month after initiation of PD, while mean PUF was 750 ± 100 ml. Hospitalizations declined from 33,2 ± 19 to 10,8 ± 17 days/patient/year. Complications were rare with no cases of peritonitis and only two patients experienced PD catheter dysfunction with the need to revise one them. CONCLUSIONS: These data suggest that PD is a safe, efficient and well-tolerated therapeutic option for patients with refractory HF. Its biggest advantage seems to be the significant decrease in hospitalization due to overhydration.