PERITONEAL ULTRAFILTRATION IN REFRACTORY HEART FAILURE: A COHORT STUDY
PERITONEAL ULTRAFILTRATION IN REFRACTORY HEART FAILURE: A COHORT STUDY
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DOI：
10.3747/pdi.2012.00290
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发表时间：
2014-01-01
影响因子：
2.8
通讯作者：
Stefania, Farina
中科院分区：
文献类型：
--
作者：
Bertoli, Silvio V.;Musetti, Claudio;Stefania, Farina
简介：利尿剂抵抗患者的急性失代偿性心力衰竭（HF）通常采用体外超滤治疗。腹膜超滤（PUF）已被提议用于急性发作缓解后严重心力衰竭的长期治疗。本研究的目的是评估 PUF 在治疗无终末期肾病的慢性难治性心力衰竭患者中的应用。 方法：这项多中心（意大利 10 个肾病科）回顾性观察研究纳入了对最大化药物治疗难治的严重心力衰竭患者。这些患者被建议接受 PUF，因为他们在前一年因急性失代偿性心力衰竭需要进行体外超滤而至少入院 3 次。 结果：在 48 名研究患者中（39 名男性，9 名女性；平均年龄 74 +/- 9 岁），30 名患者接受了 1 次夜间艾考糊精交换，5 名患者需要每天 2 次交换，13 名患者接受了每周 2 - 4 次自动腹膜透析治疗。 透析。第一年期间，肾功能保持稳定（初始：20.8 +/- 10.0 mL/min/1.73 m(2)；结束：22.0 +/- 13.6 mL/min/1.73 m2），而肺动脉收缩压从 45.5 +/- 9.18 mmHg 下降至 40 +/- 6.09 mmHg (p = 0.03)，显着降低。纽约也随之改善 心脏协会的功能状态。住院时间从 PUF 开始前的 43 +/- 33 天/患者年减少到 11 +/- 17 天/患者年 (p < 0.001)。腹膜炎的发病率为 45 个患者月内发生 1 次。患者 1 年生存率为 85%，2 年生存率为 56%。 结论：本研究证实了使用 PUF 治疗老年患者慢性心力衰竭的满意结果。
Introduction: Acutely decompensated heart failure (HF) in patients with diuretic resistance is often treated with extracorporeal ultrafiltration. Peritoneal ultrafiltration (PUF) has been proposed for the long-term management of severe HF after resolution of the acute episode. The aim of the present study was to evaluate the use of PUF in the treatment of chronic refractory HF in patients without endstage renal disease.Methods: This multicenter (10 nephrology departments throughout Italy) retrospective observational study included patients with severe HF refractory to maximized drug treatment. The patients were proposed for PUF because they had experienced at least 3 hospital admissions in the preceding year for acutely decompensated HF requiring extracorporeal ultrafiltration.Results: Of the 48 study patients (39 men, 9 women; mean age 74 +/- 9 years), 30 received 1 nocturnal icodextrin exchange, 5 required 2 daily exchanges, and 13 received 2 - 4 sessions per week of automated peritoneal dialysis. During the first year, renal function remained stable (initial: 20.8 +/- 10.0 mL/min/1.73 m(2); end: 22.0 +/- 13.6 mL/min/1.73 m2), while pulmonary artery systolic pressure declined to 40 +/- 6.09 mmHg from 45.5 +/- 9.18 mmHg (p = 0.03), with a significant concomitant improvement in New York Heart Association functional status. Hospitalizations decreased to 11 +/- 17 days/patient-year from 43 +/- 33 days/patient-year before the start of PUF (p < 0.001). The incidence of peritonitis was 1 episode in 45 patient-months. Patient survival was 85% at 1 year and 56% at 2 years.Conclusions: This study confirms the satisfactory results of using PUF for chronic HF in elderly patients.