Place of peritoneal dialysis in the management of treatment-resistant congestive heart failure

Abstract

in the United States. 3 The term ‘cardiorenal syndrome’ has been used recently to refer to the presence or development of renal dysfunction in patients with CHF. Several studies have documented the high prevalence of renal dysfunction in the presence of CHF. The Acute Decompensated Heart Failure National Registry has compiled a large database of patients with heart failure requiring hospitalization in the United States. 4 Among 105 388 patients in a recent report from this registry, 30% had an additional diagnosis consistent with chronic kidney disease. The serum creatinine exceeded 2.0 mg/dl among 20% of the patients, was higher than 3.0 mg/dl in nine patients, and 5% were receiving dialysis therapy. Surprisingly, 46% of registry patients had normal or only mild impairment in systolic function. 4 In another prospective study of 6427 patients with clinical diagnosis of CHF and angiographically proven coronary artery disease, 39% had creatinine clearances o60 ml/min. 5 Not only does renal dysfunction appears to be highly prevalent at the time of admission, it often worsens during the course of hospital stay. In two different studies, 72‐75% of patients had an increase in serum creatinine by at least 0.1 mg/dl. 6,7 Furthermore, 20‐24% of individuals experienced a rise in serum creatinine of X0.5 mg/dl. In both these studies, the degree of worsening of renal function was associated with higher risk for death. 6,7 These data suggest that ‘cardiorenal’ syndrome is a common clinical problem and it identifies a subset of patients with CHF with a high likelihood of an adverse clinical outcome.