Dialysis initiation and survival in patients with refractory congestive heart failure

Background: It has been reported that more than 30% of patients present with congestive heart failure at the initiation of renal replacement therapy (RRT). We followed up a cohort of patients with refractory congestive heart failure (RCHF) who started dialysis between 2005 and 2006 and conducted an observational cohort study in order to evaluate the clinical features at the time RRT was started, and the survival rate of patients with RCHF. Methods: Data were collected on 33 uremic subjects (24 male) with RCHF, referred by cardiologists, who started dialysis between 2005 and 2006 and were followed-up for 42 months. The following parameters were derived from clinical records: age, sex, history of ischemic heart disease (IHD), cerebrovascular disease (CVD), peripheral vascular disease (PVD), diabetes, smoking, hypertension, myeloma or malignancies, the cause for dialysis and procedure used to initiate treatment. Results: RCHF was the cause of initial RRT in 15 patients in 2005 and in 18 the following year, with an incidence of 27 out of 100 patients per year. Diabetes was diagnosed in 51% (n=17) of cases. More than 80% of patients with RCHF had histories of hypertension and smoking. IHD, CVD and PVD were present in 66%, 30% and 54% of cases, respectively. Cancers were recorded in 36% of subjects. Fluid overload was the cause of urgent dialysis in 73% of cases; a central venous catheter (CVC) was placed in 75% of patients. Mean survival of patients with RCHF was 23 months. Eighteen patients died because of cardiovascular events after a mean follow-up of 365(plus or minus)387 days; they had higher prevalence of a smoking history (100% vs. 73%, p=0.02) and CVD (44% vs. 13%, p=0.05) than the survivors. Conclusions: In uremic patients starting dialysis, RCHF appears to be a frequent condition, comorbidity is high and they require urgent treatment by CVC because of fluid overload. Since RCHF is time- and resource-consuming, nephrologists need to ameliorate its management