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      Effectiveness and Safety of Peritoneal Dialysis Treatment in Patients with Refractory Congestive Heart Failure due to Chronic Cardiorenal Syndrome

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          Abstract

          Aims

          To evaluate the effectiveness and safety of peritoneal dialysis (PD) in treating refractory congestive heart failure (RCHF) with cardiorenal syndrome (CRS).

          Methods

          A total of 36 patients with RCHF were divided into type 2 CRS group (group A) and non-type 2 CRS group (group B) according to the patients' clinical presentations and the ratio of serum urea to creatinine and urinary analyses in this prospective study. All patients were followed up till death or discontinuation of PD. Data were collected for analysis, including patient survival time on PD, technique failure, changes of heart function, and complications associated with PD treatment and hospitalization.

          Results

          There were 27 deaths and 9 patients quitting PD program after a follow-up for 73 months with an average PD time of 22.8 ± 18.2 months. A significant longer PD time was found in group B as compared with that in group A (29.0 ± 19.4 versus 13.1 ± 10.6 months, p = 0.003). Kaplan–Meier curves showed a higher survival probability in group B than that in group A ( p < 0.001). Multivariate regression demonstrated that type 2 CRS was an independent risk factor for short survival time on PD. The benefit of PD on the improvement of survival and LVEF was limited to group B patients, but absent from group A patients. The impairment of exercise tolerance indicated by NYHA classification was markedly improved by PD for both groups. The technique survival was high, and the hospital readmission was evidently decreased for both group A and group B patients.

          Conclusions

          Our data suggest that PD is a safe and feasible palliative treatment for RCHF with type 2 CRS, though the long-term survival could not be expected for patients with the type 2 CRS. Registration ID Number is ChiCTR1800015910.

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          Most cited references29

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          ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC.

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            Cardiorenal syndrome: refining the definition of a complex symbiosis gone wrong.

            The term "cardiorenal syndrome" has generally been reserved for declining renal function in the setting of advanced congestive heart failure. Considering the complex and bi-directional relationship between the heart and the kidneys, we postulate refining the definition to recognize the symbiotic nature of these organs. We divide the cardiorenal syndrome into five subtypes: type I, acute cardiorenal syndrome; type II, chronic cardiorenal syndrome; type III, acute renocardiac syndrome; type IV, chronic renocardiac syndrome; and type V, secondary cardiorenal syndrome. As early recognition of dysfunction in one organ may prove important in mitigating the spiral of co-dysfunction in both, the need for early and treatment-guiding biomarkers, along with their characteristics, are also discussed.
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              Acute decompensated heart failure and the cardiorenal syndrome.

              Heart failure is one of the leading causes of hospitalizations in the United States. Concomitant and significant renal dysfunction is common in patients with heart failure. Increasingly, the syndrome of heart failure is one of cardiorenal failure, in which concomitant cardiac and renal dysfunctions exist, with each accelerating the progression of the other. One fourth of patients hospitalized for the treatment of acute decompensated heart failure will experience significant worsening of renal function, which is associated with worse outcomes. It remains unclear whether worsening renal function specifically contributes to poor outcomes or whether it is merely a marker of advanced cardiac and renal dysfunction. Diuretic resistance, with or without worsening renal function, is also common in acute decompensated heart failure, although the definition of diuretic resistance, its prevalence, and prognostic implications are less well defined. The term cardiorenal syndrome has been variably associated with cardiorenal failure, worsening renal function, and diuretic resistance but is more comprehensively defined as a state of advanced cardiorenal dysregulation manifest by one or all of these specific features. The pathophysiology of the cardiorenal syndrome is poorly understood and likely involves interrelated hemodynamic and neurohormonal mechanisms. When conventional therapy for acute decompensated heart failure fails, mechanical fluid removal via ultrafiltration, hemofiltration, or hemodialysis may be needed for refractory volume overload. While ultrafiltration can address diuretic resistance, whether ultrafiltration prevents worsening renal function or improves outcomes in patients with cardiorenal syndrome remains unclear. Evidence regarding the potential renal-preserving effects of nesiritide is mixed, and further studies on the efficacy and safety of different doses of nesiritide in heart failure therapy are warranted. Newer therapeutic agents, including vasopressin antagonists and adenosine antagonists, hold promise for the future, and clinical trials of these agents are underway.
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                Author and article information

                Contributors
                Journal
                Biomed Res Int
                Biomed Res Int
                BMRI
                BioMed Research International
                Hindawi
                2314-6133
                2314-6141
                2018
                17 May 2018
                : 2018
                : 6529283
                Affiliations
                1Department of Nephrology, Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
                2Department of Cardiology, Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
                3Department of Medicine, University of Toledo College of Medicine, Toledo, OH, USA
                Author notes

                Academic Editor: Claudio De Lucia

                Author information
                http://orcid.org/0000-0001-7314-1275
                http://orcid.org/0000-0001-7259-298X
                http://orcid.org/0000-0002-5934-6570
                Article
                10.1155/2018/6529283
                5985089
                db75f5eb-88f6-4987-8d77-cf6bc267561f
                Copyright © 2018 Qiuyuan Shao et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 29 September 2017
                : 27 March 2018
                : 2 April 2018
                Funding
                Funded by: General Science and Technology Development Program of Nanjing City
                Award ID: YKK16096
                Funded by: General Program of Jiangsu Health and Family Planning Commission Foundation
                Award ID: H201645
                Categories
                Clinical Study

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