Efficacité de la dialyse péritonéale dans le traitement de l'insuffisance cardiaque réfractaire (efficacy of peritoneal dialysis in the treatment of refractory heart failure)

Heart failure (HF) is a progressive disorder even with adequate treatment. Fluid removal may aid in the management of these patients. We evaluated the efficacy of peritoneal dialysis (PD) in the treatment of refractory HF.Patients and Methods : Prospective, non-randomized study involving patients with congestive HF refractory to maximun tolerable drug treatment. All of them were treated with PD. We analysed clinical data and functional status. To determine efficacy we compared the perceived state of health to PD patients respect to those reported with conservative therapies. Finally, we carried out a cost-utility evaluation.Results : Seventy-eight patients (68% men, 66±10 years) were included and 14 were still undergoing PD at the end of the follow-up period (22±9 months). Seventy patients underwent only one daily nocturnal exchange; the rest, 2 or 3 exchanges according to different degrees of renal failure. All of them improved their NYHA functional status, (4% three classes, 63% two, 33% one; p<0.001), with a reduction in their pulmonary artery systolic pressure (48±13 vs 28±10 mmHg; p=0.007). Hospitalization rates underwent a dramatic reduction (from 63±16 to 9±7 days/patient/year; p=0.002). Life expectancy on PD was 88% after 12 months of treatment, and 72% and 54% after 18 and 24 months. PD was associated with a perceived state of health higher than with conservative therapy, (0,416±0,218 vs 0, 658±0,114, p <0.02 ). PD is cost-effective compared with the diuretic regimens.Conclusions : PD is a good option for patients with refractory HF; it improves the functional status and quality of life, reduces morbidity, mortality and health care costs.L’insuffisance cardiaque (IC) est une maladie progressive, même avec un traitement adéquat. La soustraction hydrique peut aider à la prise en charge de ces patients. Nous avons évalué l’efficacité de la dialyse péritonéale (DP) dans le traitement de l’IC réfractaire.Patients et Méthodes : Étude prospective non randomisée impliquant des patients atteints d’IC congestive réfractaire à un traitement médicamenteux maximum tolérable. Tous ont été traités par DP. Nous avons analysé les données cliniques et l’état fonctionnel. Pour déterminer l’efficacité, nous avons comparé l’état de santé perçu aux patients atteints de la maladie de Parkinson par rapport à ceux rapportés avec des thérapies conservatrices. Enfin, nous avons effectué une évaluation coût-bénéfice.Résultats : Soixante-dix-huit patients (68% d’hommes, 66 ± 10 ans) ont été inclus et 14 étaient encore en DP à la fin de la période de suivi (22 ± 9 mois). Soixante-dix patients ont eu seulement un échange nocturne quotidien; le reste, 2 ou 3 échanges selon la fonction rénale résiduelle. Tous ont amélioré leur statut fonctionnel NYHA, (4% trois classes, 63% deux, 33% une, P <0,001), avec une réduction de leur pression artérielle systolique pulmonaire (48 ± 13 vs 28 ± 10 mmHg, p = 0,007) . Les taux d’hospitalisation ont subi une réduction spectaculaire (de 63 ± 16 à 9 ± 7 jours / patient / an, p = 0,002). L’espérance de vie en DP était de 88% après 12 mois de traitement, et 72% et 54% après 18 et 24 mois. La DP était associée à un état de perception de la santé supérieur à celui de la thérapie conservatrice (0,416 ± 0,218 vs 0, 658 ± 0,114, P <0,02). La DP est rentable par rapport aux régimes diurétiques.Conclusions : La DP est une bonne option pour les patients avec IC réfractaire; elle améliore l’état fonctionnel et la qualité de vie, réduit la morbidité, la mortalité et les coûts des soins de santé. Abstract Heart failure (HF) is a progressive disorder even with adequate treatment. Fluid removal may aid in the management of these patients. We evaluated the efficacy of peritoneal dialysis (PD) in the treatment of refractory HF.Patients and Methods : Prospective, non-randomized study involving patients with congestive HF refractory to maximun tolerable drug treatment. All of them were treated with PD. We analysed clinical data and functional status. To determine efficacy we compared the perceived state of health to PD patients respect to those reported with conservative therapies. Finally, we carried out a cost-utility evaluation.Results : Seventy-eight patients (68% men, 66±10 years) were included and 14 were still undergoing PD at the end of the follow-up period (22±9 months). Seventy patients underwent only one daily nocturnal exchange; the rest, 2 or 3 exchanges according to different degrees of renal failure. All of them improved their NYHA functional status, (4% three classes, 63% two, 33% one; p<0.001), with a reduction in their pulmonary artery systolic pressure (48±13 vs 28±10 mmHg; p=0.007). Hospitalization rates underwent a dramatic reduction (from 63±16 to 9±7 days/patient/year; p=0.002). Life expectancy on PD was 88% after 12 months of treatment, and 72% and 54% after 18 and 24 months. PD was associated with a perceived state of health higher than with conservative therapy, (0,416±0,218 vs 0, 658±0,114, p <0.02 ). PD is cost-effective compared with the diuretic regimens.Conclusions : PD is a good option for patients with refractory HF; it improves the functional status and quality of life, reduces morbidity, mortality and health care costs