A Preliminary Case-Control Study: Peritoneal Approach in Congestive Heart Failure Treatment.

BACKGROUND: Congestive heart failure (CHF) associated with worsening renal function is a very common disorder, and, as well known, the goal of the treatment is reducing venous congestion and maintaining a targeted extracellular volume. The objective of the study is to evaluate regular peritoneal ultrafiltration treatment compared to a standard conservative approach in NYHA III-IV CHF patients. In particular, the primary endpoints of the study were the major event-free survival and the total days of medical care per month (which consist of the days of hospitalization and the number of outpatient visits). MATERIAL AND METHODS: This is a retrospective case-control study. Twenty-four patients were included in the present study. Twelve consecutive patients were treated with peritoneal treatment (group A) and 12 matched for age, gender, and severity of disease with a standard approach. Patients were observed over a maximum period of 18 months. Information on events, hospitalizations, and number of visits was collected during follow-up. RESULTS: During the follow-up, we observed a major event in 4 patients in group A (33.3%) and in 8 patients in group B (66.7%). In group B, we observed 7 deaths and 1 ICD shock, while in group A, 3 deaths and 1 ICD shock. The number of visits per month was significantly lower in patients treated with the peritoneal method (1.2 [0.4-4.1] vs. 2.5 [2.0-3.1]; p = 0.03). The total days of medical care was significantly lower in group A (2.0 [1.1-5.5] vs. 4.4 [3.0-8.7]; p = 0.034). A multiple event analysis according to the Andersen-Gill model showed a significant event-free survival for group A. During the follow-up, we did not observe any episode of peritonitis in the treated group. CONCLUSIONS: Our study shows that the peritoneal technique is a good therapeutic tool in well-selected patients with CHF. In accordance with prior experience, this intervention has not only an important and significant clinical impact but also potential economic and social consequences.

[HFR aequilibrium can be an answer to malnutrition and hypotension in dialisys: case report]. / Uso dell'HFR aequilibrium come risposta all'ipotensione ed alla malnutrizione dialitica: case report.

The interdialytic hypotension is still the most frequent complication during the hemodialysis. A-HFR has dynamic profiles of ultrafiltration and conductivity of the dialysate that ensure a better refilling and reduce compliance during the dialysis treatment, furthermore reduce the amino acid loss and has a lower inflammatory effect. In our Center, we wanted to analyze the impact of this kind of dialysis on intradialytic tolerance and nutritional status in two malnourished patients with encouraging data on the use of AHFR in malnutrition and disequilibrium syndromes.