EFFECT OF PERITONEAL DIALYSIS ON CARDIAC FUNCTIONAL PARAMETERS IN PATIENTS WITH CONGESTIVE HEART FAILURE.
Panagiotis Pangidis1, Foteini Lazaridou2, Andreas Bozikas1, Iliana Kiriakoutzik1, Theotokis Kaltzidis2, Eleni Kitoukidi1, Pinelopi Pisanidou1, Eva Stamatopoulou2, Ioannis Tsounos2, Sofia Spaia1 .
1“Agios Pavlos”, Nephrology Department, Thessaloniki, Greece.
2“Agios Pavlos”, Cardiology Department, Thessaloniki, Greece.
Introduction and aims: Limited data support that peritoneal dialysis (PD) applied in patients (pts) with congestive heart failure (CHF), resistant to diuretic therapy, results in significant improvement of their status. We examined the long term effect of PD, as a continuous ultrafiltration treatment to pts with CHF, NYHA stage IV and renal disease stage > IIIb on cardiac functional parameters. We have applied a detailed Cardiac Ultrasound (CU) examination in an effort to identify markers to distinguish population that might benefit of early PD application.
Methods: We enrolled 18 pts (mean age 80.3 years) in PD. Inclusion criteria were NYHA IV class symptoms and deterioration of renal function. Monthly complete biochemical workup and assessment of the cardiac function by (CU) on the initiation of PD and 6 – 12 months later was performed.
We recorded and evaluated the Ejection Fraction (LVEF), Relative Wall Thickness (RWT), Left Ventricular Mass Index (LV mass index), Ε/Ε’, Left Atrium Volume Index (LA volume index), Pulmonary Artery Systolic Pressure (PASP), Tricuspid Annular Plane Systolic Excursion (TAPSE).
Results: Follow up was 10.1 (6 – 12) months. As it was expected we observed body weight decrease (p = 0.0083), improved eGFR (p = 0.026), decrease of bilirubin levels (p = 0.0475), substantial decrease of diuretics, as well as elimination of hospitalizations due to CHF decompensation and remarkable improvement of NYHA class. Significant reductions of LV mass index and LA volume index (p < 0.05) were noted in every patient. The rest of the parameters remained unaffected. LVEF showed equivocal changes. One pt died on the 8th month of therapy due to sudden death.
Conclusions: All pts demonstrated clinical improvement as demonstrated by NYHA classification, as a result of the gradual and continuous removal of excess fluid. Therefore, dramatically diminishing hospitalizations, due to cardiac events, and restoring pts autonomy. Furthermore, there was an improvement of left cardiac function. However, markers of right cardiac function did not change, probably due to technical or individualized causes. For the same reasons interpretation of LVEF changes is ambiguous and cannot be used as an objective marker to identify this population. The results of this prospective, but small sized, study encourage the application of PD in selected pts with CHF.
PDF