Long-Term Impact of Peritoneal Dialysis Ultrafiltration on Cardiorenal Patients

Abstract

Cardiorenal syndrome; Diuretic resistance; Heart failure

Síndrome cardiorenal; Resistència diürètica; Insuficiència cardíaca

Síndrome cardiorrenal; Resistencia diurética; Insuficiencia cardíaca

Background: Heart failure (HF) prevalence is increasing, and its prognosis worsens in the presence of other comorbidities. Up to 70% of patients develop cardiorenal syndrome (CRS), which is associated with diuretic resistance or kidney deterioration over time. Peritoneal dialysis (PD) for ultrafiltration (PD-UF) could be a potential therapeutic option in CRS, although its long-term outcomes have not been described. Methods: Retrospective registry study of the Catalan Renal Registry on patients with PD-UF indication between 2013 and 2022. Baseline clinical characteristics and follow-up until December/2022 was studied. Results: Of the 1,874 incident patients on PD, 198 (10.6%) were PD-UF, 73.2% of the patients were male, and the mean age was 70.7 ± 9.3 years. Median estimated glomerular filtration rate (eGFR) at start was 22.6 (IQR: 14.8–32.8) mL/min×1.73 m2 and 75.0% have an eGFR above 15 mL/min×1.73 m2. Previous history of ischemic heart disease, arrhythmia, or cardiac surgery was recorded, and 57.6% of patients had ≥2 of these pathologies. The most common HF etiology was ischemic heart disease in 21.7% of patients. Median overall patient survival was 21 (IQR: 17.3–24.3) months. Technique survival at 1 year was 94.8%, and 27 patients were transferred to other renal replacement therapy (hemodialysis or kidney transplantation). In the Cox multivariate analysis, age ≥75 years (HR: 1.76 [95% CI: 1.20–2.59]), mild frailty (HR: 2.18 [95% CI: 1.17–2.59]), severe frailty (HR: 17.62 [95% CI: 1.20–55.48]), and the burden of cardiac disease (2 categories HR: 2.17 [95% CI: 1.05–4.47]; 3 categories HR: 2.26 [95% CI: 1.05–4.89]) were associated with poor overall survival. Technique survival was associated with eGFR (<30 mL/min×1.73 m2 HR: 5.64 [95% CI: 1.32–24.18]) and body mass index (<20 kg/m2 HR: 6.53 [95% CI: 1.06–40.12]) at baseline. Conclusion: PD-UF is a feasible option in patients with advanced HF and CRS. The complexity of this population increases with older age, frailty, and higher cardiac burden.

M.J.S. received research funding from the Carlos III Health Institute (PI21/01292, PI24/01510). J.L.R. received a Rio Hortega grant from the Instituto de Salud Carlos III (CM23/00213). The authors are also recipients of other research grants from Instituto de Salud Carlos III (AC22/00029) and the Fundació la Marató de TV3 (202017-10, 202037-31, and 202133-30). The Nephrology and Transplantation group is part of the RICORS2040 network (RD21/0005/0016 and RD24/0004/0031) and is recognized as a consolidated group by the Catalan Management Agency for University and Research Grants (2021 SGR 00883).