Aim: This study aimed to explore the role of peritoneal ultrafiltration (UF) in cardiorenal syndrome (CRS) patients for fluid and metabolic control. Background: Peritoneal UF is safely and efficiently used for the management of CRS. It has been shown to provide efficient UF in hypervolemic patients. Methods: Thirty (20 males and 10 females) CRS patients were treated by peritoneal dialysis (PD) and UF. The baseline data of the patients (demographics, causes of heart failure, the presence of pacemaker or implantable cardioverter-defibrillator, the need for extracorporeal UF or paracentesis or thoracentesis, comorbidity, drugs, left ventricular ejection fraction [LVEF] and pulmonary artery systolic pressure [PAPs], pericardial effusion, physical examination, body weight, NYHA class, dialysis regime, urine output, N-terminal pro-B-type natriuretic peptide [NT-proBNP] level, hemoglobin, estimated glomerular filtration rate [eGFR], and other routine biochemical determinations) were recorded at the onset, every 6 months, and then annually. Echocardiograms were performed at baseline and after 6 and 12 months. The time points of complications associated with PD, the need for hemodialysis, the day of death, and causes of death were documented. Results: Mean age was 69 ± 8 years (range 49–84 years). The average PD duration was 18.25 ± 14.87 months. According to the CKD-EPI, initial mean GFR was 34.34 ± 11.9 mL/min/1.73 m² (range 16.57–59.0), and this increased to 45.48 ± 26.04, 45.10 ± 28.58, and 41.10 ± 25.68 mL/min/1.73 m² in the third, sixth, and twelfth months, respectively. There was a significant increase in the first 3 months and a significant decrease between the third and twelfth months (respectively, p = 0.018 and p = 0.043). There was no difference in eGFR levels between baseline and the end of the first year (p = 0.217). In the first 3 months, there was a significant decline in urea levels to 79.38 ± 36.65 from 109.92 ± 42.44 mg/dL and this was maintained until the end of the first year of PD therapy (after 3 months, p = 0.002; after 1 year, p = 0.024). However, there was no significant change in creatinine levels within the first year (p = 0.312). There was a significant increase in hemoglobin level up to the end of the first year of PD (after 3 months, p = 0.000; after 12 months, p = 0.013). There was a marked decrease in NT-proBNP levels in the first 6 months (p = 0.011). Functional capacity (according to NYHA classification) improved in all patients by the third month of PD treatment (p #x3c; 0.001). This early improvement was maintained in many patients during the following 12 months (p #x3c; 0.001). There was a marked decrease in NT-proBNP levels in the first 6 months (p = 0.011). At the end of the first year, there was an approximate 15% reduction in NT-proBNP levels (p = 0.647). Hospitalizations decreased to 6 ± 15 days/patient-year (range 18–122 days) from 62 ± 24 days/patient-year (p = 0.000). Conclusion: Peritoneal UF is a treatment method that maintains renal function and electrolyte balance, improves cardiac function, and reduces hospitalizations in CRS patients. We observed that this treatment significantly increased functional capacity and quality of life and significantly reduced hospital admissions.
Cardiorenal Med

中文翻译：

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无终末期肾病的利尿剂抵抗性心力衰竭患者腹膜超滤的有用性

目的：本研究旨在探讨腹膜超滤（UF）在心肾综合征（CRS）患者的体液和代谢控制中的作用。背景：腹膜超滤可安全有效地用于 CRS 的管理。它已被证明可以为高血容量患者提供有效的超滤。方法：30 名（20 名男性和 10 名女性）CRS 患者接受了腹膜透析 (PD) 和 UF 治疗。患者的基线数据（人口统计学、心力衰竭的原因、起搏器或植入式心律转复除颤器的存在、体外超滤或腹腔穿刺术或胸腔穿刺术的需要、合并症、药物、左心室射血分数 [LVEF] 和肺动脉收缩压[PAP]、心包积液、体格检查、体重、NYHA 分级、透析方案、尿量、N 端前 B 型利钠肽 [NT-proBNP] 水平、血红蛋白、估计的肾小球滤过率 [eGFR] 和其他常规生化测定）在开始时记录，每 6 个月记录一次，然后每年记录一次。超声心动图在基线和 6 个月和 12 个月后进行。结果：平均年龄为 69 ± 8 岁（范围 49-84 岁）。平均 PD 持续时间为 18.25 ± 14.87 个月。根据 CKD-EPI，初始平均 GFR 为 34.34 ± 11.9 mL/min/1.73 m ²（范围 16.57–59.0），并且增加到 45.48 ± 26.04、45.10 ± 28.58 和 41.10 ± 25 mL/35。 ²在第三，第六，和第十二个月。前 3 个月显着增加，第三个月和第十二个月之间显着减少（分别为p = 0.018 和p = 0.043）。基线和第一年末的 eGFR 水平没有差异 ( p= 0.217）。在前 3 个月，尿素水平从 109.92 ± 42.44 mg/dL 显着下降至 79.38 ± 36.65，并一直保持到 PD 治疗的第一年结束（3 个月后，p = 0.002；1年，p = 0.024）。然而，第一年内肌酐水平没有显着变化（p = 0.312）。直到 PD 的第一年末，血红蛋白水平显着增加（3 个月后，p = 0.000；12 个月后，p = 0.013）。前 6 个月 NT-proBNP 水平显着下降（p= 0.011）。到 PD 治疗的第三个月，所有患者的功能能力（根据 NYHA 分类）都有所改善（p #x3c；0.001）。在接下来的 12 个月内，许多患者保持了这种早期改善（p #x3c；0.001）。前 6 个月 NT-proBNP 水平显着降低（p = 0.011）。在第一年年底，NT-proBNP 水平下降了大约 15% ( p = 0.647)。住院时间从 62 ± 24 天/患者年减少到 6 ± 15 天/患者年（范围 18-122 天）（p = 0.000）。结论：腹膜超滤是一种维持肾功能和电解质平衡，改善心功能，减少 CRS 患者住院的治疗方法。我们观察到这种治疗显着提高了功能能力和生活质量，并显着减少了住院率。
心肾医学