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Cardiovascular Disease |
Policlinico Umberto I, Rome, Italy
Objective: The increment of cardiovascular (CV) mortality in
patients (pts) on hemodialysis is known. It is more evident if vascular
pathologies are associated like diabetes (DM) and/or hypertension (HP). All
that would seem to be in relation with the hemodynamic* instability
that the extracorporeal techniques involve. A program of treatment of
peritoneal dialysis (PD) can guarantee to pts a constant UF that concurs to
give a better hemodynamic stability so to prevent CV accidents.
Methods: We tried to evaluate if pts with ESRD (K/DOQI stage V) and
cardiac lack of balance in III–IV class NYHA draw benefits on the
cardiac performance from a renal substitutive treatment with the PD. From
March 2001 to January 2007 we put in PD 16 pts, aged between 31 and 83 years,
with ESRD. 10 of them were affected of heart disease (class III–IV
NYHA), and introducing also comorbidity: DM (6 pts) and HP (8 pts).All the pts
have been followed for a mean time of 20.6±19.4 months (maximum period
of 60 months; minimum of 3 months). Results: At the beginning of the
PD the pts had a mean dry weight of 79.6±11.9 kg; a mean 24-hour
diuresis of 1638± 527 mL; the UF was 585±527 mL, the residual
creat clearance was 8.3± 4.5 mL/min (ranged between a minimum of 5
mL/min and a maximum of 18.7 mL/min). All the pts showed a cardiac ECD picture
showing a CV engagement: mean FE 42±7%. The obtained data showed a
recovery of the renal function with mean values of 14.2±2.1 mL/min with
an unchanged diuresis. Also the UF is increased until to medium values of
975±245 mL/24 hours. We obtained a graduates reduction of the CV
overload with a reduction of class NYHA in all the pts, and a FE of
50.4±10.7%. Conclusions: PD could be a valid therapeutic
option in pts with cardiac lack of balance and ESRD; it allows to obtain a
constant and graduated UF so to escape from quick alterations of the
circulating volume. Moreover a meaningful improvement of cardiac performance
has been observed, with increase of the FE also of 25% in some pts. Such
increase of the FE has carried also a consequent increase of renal
perfusion.
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