| Theme |
The initiation and maintenance of dialysis in terms of original kidney diseases and complications |
| Title |
Impact of peritoneal dialysis in patients with severe heart failure |
| Author |
Yoshimitsu Hayashi |
Department of Nephrology and Hypertension, Fukushima Medical University School of Medicine |
| Author |
Masaaki Nakayama |
Department of Nephrology and Hypertension, Fukushima Medical University School of Medicine |
| [ Summary ] |
Severe heart failure is a leading cause of death, especially when it is concomitant with chronic kidney disease. However, peritoneal dialysis (PD) can reduce hospitalization times and safely improve symptoms because of the slow ultrafiltration times for patients with severe heart failure. Compared to glucose PD solutions, icodextrin PD solutions removes excess fluid independently of patient's peritoneal functions. As a result, incremental PD with nocturnal icodextrin is effective in maintaining residual renal functions. In contrast, PD is less effectiveness in preventing heart failure than hemodialysis (HD) when patients have lost residual renal functions. Severe hypotension resulting from fast ultrafiltration with intermitted HD is also a major problem for patients with heart failure. PD+HD combination therapy is available in japan. This method is efficacious for patients with severe heart failure with end stage renal failure because of the complementary affect of ultrafiltration with slow but imprecise PD or fast but precise HD. |