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Dialysis May Help Some Patients with Treatment-Resistant CHF

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Dialysis may improve outcomes in patients suffering from treatment-resistant congestive heart failure (CHF) accompanied by severe renal insufficiency, new findings suggest.

Trijntje T. Cnossen, MD, PhD, of the Maastricht University Medical Center in Maastricht, The Netherlands, prospectively studied 23 hypervolemic patients with CHF complicated by progressive and permanent chronic renal insufficiency. The patients were classified as having cardiorenal syndrome (CRS) Type 2. All subjects had failed treatment with high-dose intravenous diuretics.

Twelve patients were treated with peritoneal dialysis (PD) and 11 were treated with intermittent hemodialysis (IHD). The median survival time after the start of dialysis was 16 months. Hospitalizations for cardiovascular causes decreased significantly from 1.4 days/patient/month pre-dialysis to 0.4 days/patient/month post-dialysis, the researchers reported online ahead of print in Nephrology Dialysis Transplantation. The investigators observed no significant change in hospitalizations for all causes. The authors noted that “hospitalizations for non-cardiovascular causes appeared to be especially pronounced in patients who were already hospitalized at the start of dialysis and were in general not related to complications of the treatment.”

In addition, New York Heart Association class improved significantly from 3.8 at the start of dialysis to 2.4 after eight months. Dr. Cnossen's team observed no significant change in left ventricular ejection fraction. The investigators reported a relatively high number of technical complications associated with dialysis.

The finding of a reduction in hospitalization for cardiovascular causes after starting dialysis is consistent with early published studies, including a retrospective study by Dr. Cnossen and colleagues. That study, which was published in Blood Purification (2010;30:146-152), included 24 patients with CRS Type 2 treated with PD. The number of hospitalizations for cardiovascular causes decreased significantly from 13.7 days/patient/month pre-dialysis to 3.5 days/patient/month post-dialysis. The study population had a median survival of one year, but 12 patients who survived longer also had a significantly decreased number of hospitalizations for all causes (from 3.7 to 1.4 days/patient/month).

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