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Timóteo AT, Mano TB. Efficacy of peritoneal dialysis in patients with refractory congestive heart failure: a systematic review and meta-analysis. Heart Fail Rev 2023; 28:1053-1063. [PMID: 36738391 PMCID: PMC10403434 DOI: 10.1007/s10741-023-10297-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/25/2023] [Indexed: 02/05/2023]
Abstract
Refractory congestive heart failure (RCHF) is a common complication in the natural history of advanced heart failure. Peritoneal dialysis (PD) is a possible alternative in those patients, but studies are scarce, and mostly with small samples. We conducted this meta-analysis to evaluate the effects of PD in patients with RCHF. Articles published before July 2020 in the following databases: PubMed, Web of Science, and CENTRAL. Mean differences (MD) and 95% confidence intervals (CIs) were computed to generate a pooled effect size with a random effects model. We also assessed heterogeneity, risk of bias, publication bias, and quality of evidence. Twenty observational studies (n = 769) were included, with a "before and after intervention" design. PD was associated with a significant reduction in NYHA functional class (MD -1.37, 95% CI -0.78 to -1.96) and length of hospitalisation (MD -34.8, 95% CI -20.6 to -48.9 days/patient/year), a small but significant increase in left ventricular ejection fraction (MD 4.3, 95%CI 1.9 to 6.8%) and a non-significant change in glomerular filtration rate (MD -3.0, 95% CI -6.0 to 0 mL/min/1.73m2). Heterogeneity among studies was significant and overall risk of bias was rated from moderate to critical. No significant publication bias was found, and the overall quality of evidence was very low for all outcomes. PD in patients with RCHF improved functional class, length of hospitalisation, and ventricular functional, and had no impact in renal function. Further randomised clinical trials are warranted to confirm our results that showed some limitations.
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Affiliation(s)
- Ana Teresa Timóteo
- Cardiology Department, Santa Marta Hospital, Centro Hospitalar Universitário Lisboa Central, Rua Santa Marta, 1169-025, Lisbon, Portugal.
- NOVA Medical School, Lisbon, Portugal.
| | - Tânia Branco Mano
- Cardiology Department, Santa Marta Hospital, Centro Hospitalar Universitário Lisboa Central, Rua Santa Marta, 1169-025, Lisbon, Portugal
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Kutsal DA, Yıldırımtürk Ö, Sungur A, Sungur MA, Kayahan M, Güngör B. Peritoneal dialysis for refractory heart failure: A single center experience. Ther Apher Dial 2021; 26:1007-1013. [PMID: 34953176 DOI: 10.1111/1744-9987.13785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 12/18/2021] [Accepted: 12/22/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Heart failure is a disease associated with poor quality of life. Peritoneal dialysis can be an alternative in treatment of these patients to overcome fluid overload. The objective of this study is to observe the effects of peritoneal dialysis in refractory heart failure patients. METHODS We conducted an observational study including 10 patients with refractory congestive heart failure. Peritoneal dialysis started solely for fluid overload. Patients' baseline parameters were compared with follow-up parameters. RESULTS Median age was 57.5 (44.8-64.3) years. Median left ventricular ejection fraction was 20% (18.8-31.3) and all patients had right ventricular dysfunction. Median estimated glomerular filtration rate was 51.2 (43.8-101.3) ml/min/1.73 m2 . 2 patients (20%) died during the follow-up period. NewYork Heart Association functional class decreased significantly from a median of 4 to 2,1 and 1 in the 3rd, 6th and 12th month respectively (p ≤ 0.01 for all from baseline). Number and length of hospitalization decreased significantly after treatment (number from a median of 3 to 0, p = 0.013; days from 50.5 to 0, p = 0.028). CONCLUSION Peritoneal dialysis significantly reduced NewYork Heart Association functional class, number and days of hospitalization for heart failure. It could be a reasonable option in chronic treatment of patients with refractory heart failure. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Dilek Aslan Kutsal
- Department of Nephrology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Özlem Yıldırımtürk
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Aylin Sungur
- Department of Cardiology, Süreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, İstanbul, Turkey
| | - Mustafa A Sungur
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Münire Kayahan
- Department of General Surgery, Haydarpaşa Numune Training and Research Hospital, İstanbul, Turkey
| | - Barış Güngör
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
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Banerjee D, Wang AYM. Personalising heart failure management in CKD patients. Nephrol Dial Transplant 2021; 37:2055-2062. [PMID: 33591313 DOI: 10.1093/ndt/gfab026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Indexed: 12/19/2022] Open
Abstract
CKD in heart failure patients is common, present in 49%, associated with higher mortality [Hazard ratio, 2.34 (95% CI2.20-2.50, P < 0.001) and multiple hospital admissions. The management of heart failure in CKD can be challenging due to drug induced electrolyte and creatinine changes; resistance to diuretics and infections related to device therapy. Evidence for improvement in mortality and heart failure hospitalisations exists in HFrEF stage 3 CKD patients from randomised controlled trials of ACE-inhibitor and mineralocorticoid receptor antagonist therapy; but not in dialysis patients where higher doses can cause hyperkalaemia. Evidence on improvement of cardiovascular death and heart failure hospitalisations has emerged with angiotensin blocker-neprilysin inhibitor, ivabradine and more recently with sodium-glucose cotransporter inhibitors in HFrEF patients with CKD stages 1,2, and 3. However these studies have excluded CKD 4,5 patients. Evidence for betablocker therapy exists in CKD stages 1,2 and 3 and separately in haemodialysis patients. Cardiac resynchronisation therapy reduces heart failure hospitalisations and mortality in patients with CKD 1,2,3 but not in CKD stages 4,5 or dialysis patients. Internal cardioverter and defibrillator therapy in HFrEF patients have been shown to be beneficial in CKD 3 patients, not in dialysis patients where it is associated with high rates of infection. For HFpEF patients with CKD therapy is symptomatic as there is no proven therapy for improvement in survival or hospitalisations. Heart failure patients with end-stage-kidney disease with fluid overload may benefit from peritoneal dialysis. A multidisciplinary, personalised approach has been associated with better care and improved patient satisfaction.
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Affiliation(s)
- Debasish Banerjee
- Renal and Transplantation Unit, St George's University Hospitals NHS Foundation Trust; Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Research Institute; St George's, University of London; Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Angela Yee-Moon Wang
- Renal and Transplantation Unit, St George's University Hospitals NHS Foundation Trust; Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Research Institute; St George's, University of London; Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong
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Sahin E, Gökçay Bek S, Eren N, Karauzum I, Ergul M, Yildiz N, Sahin T, Dervisoglu E, Kalender B. Usefulness of Peritoneal Ultrafiltration in Patients with Diuretic Resistant Heart Failure without End-Stage Renal Disease. Cardiorenal Med 2020; 10:429-439. [PMID: 33022682 DOI: 10.1159/000510249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/11/2020] [Indexed: 11/19/2022] Open
Abstract
AIM This study aimed to explore the role of peritoneal ultrafiltration (UF) in cardiorenal syndrome (CRS) patients for fluid and metabolic control. BACKGROUND Peritoneal UF is safely and efficiently used for the management of CRS. It has been shown to provide efficient UF in hypervolemic patients. METHODS Thirty (20 males and 10 females) CRS patients were treated by peritoneal dialysis (PD) and UF. The baseline data of the patients (demographics, causes of heart failure, the presence of pacemaker or implantable cardioverter-defibrillator, the need for extracorporeal UF or paracentesis or thoracentesis, comorbidity, drugs, left ventricular ejection fraction [LVEF] and pulmonary artery systolic pressure [PAPs], pericardial effusion, physical examination, body weight, NYHA class, dialysis regime, urine output, N-terminal pro-B-type natriuretic peptide [NT-proBNP] level, hemoglobin, estimated glomerular filtration rate [eGFR], and other routine biochemical determinations) were recorded at the onset, every 6 months, and then annually. Echocardiograms were performed at baseline and after 6 and 12 months. The time points of complications associated with PD, the need for hemodialysis, the day of death, and causes of death were documented. RESULTS Mean age was 69 ± 8 years (range 49-84 years). The average PD duration was 18.25 ± 14.87 months. According to the CKD-EPI, initial mean GFR was 34.34 ± 11.9 mL/min/1.73 m2 (range 16.57-59.0), and this increased to 45.48 ± 26.04, 45.10 ± 28.58, and 41.10 ± 25.68 mL/min/1.73 m2 in the third, sixth, and twelfth months, respectively. There was a significant increase in the first 3 months and a significant decrease between the third and twelfth months (respectively, p = 0.018 and p = 0.043). There was no difference in eGFR levels between baseline and the end of the first year (p = 0.217). In the first 3 months, there was a significant decline in urea levels to 79.38 ± 36.65 from 109.92 ± 42.44 mg/dL and this was maintained until the end of the first year of PD therapy (after 3 months, p = 0.002; after 1 year, p = 0.024). However, there was no significant change in creatinine levels within the first year (p = 0.312). There was a significant increase in hemoglobin level up to the end of the first year of PD (after 3 months, p = 0.000; after 12 months, p = 0.013). There was a marked decrease in NT-proBNP levels in the first 6 months (p = 0.011). Functional capacity (according to NYHA classification) improved in all patients by the third month of PD treatment (p < 0.001). This early improvement was maintained in many patients during the following 12 months (p < 0.001). There was a marked decrease in NT-proBNP levels in the first 6 months (p = 0.011). At the end of the first year, there was an approximate 15% reduction in NT-proBNP levels (p = 0.647). Hospitalizations decreased to 6 ± 15 days/patient-year (range 18-122 days) from 62 ± 24 days/patient-year (p = 0.000). CONCLUSION Peritoneal UF is a treatment method that maintains renal function and electrolyte balance, improves cardiac function, and reduces hospitalizations in CRS patients. We observed that this treatment significantly increased functional capacity and quality of life and significantly reduced hospital admissions.
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Affiliation(s)
- Elif Sahin
- Internal Medicine, Kocaeli University Hospital, Kocaeli, Turkey
| | | | - Necmi Eren
- Nephrology, Kocaeli University Hospital, Kocaeli, Turkey
| | - Irem Karauzum
- Cardiology, Kocaeli University Hospital, Kocaeli, Turkey
| | - Metin Ergul
- Nephrology, Kocaeli University Hospital, Kocaeli, Turkey
| | - Nuriye Yildiz
- Nephrology, Kocaeli University Hospital, Kocaeli, Turkey
| | - Tayfun Sahin
- Cardiology, Kocaeli University Hospital, Kocaeli, Turkey
| | | | - Betul Kalender
- Nephrology, Kocaeli University Hospital, Kocaeli, Turkey
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Chionh CY, Clementi A, Poh CB, Finkelstein FO, Cruz DN. The use of peritoneal dialysis in heart failure: A systematic review. Perit Dial Int 2020; 40:527-539. [PMID: 32063182 DOI: 10.1177/0896860819895198] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Heart failure (HF) is a major cause of morbidity and mortality. Extracorporeal (EC) therapy, including ultrafiltration (UF) and haemodialysis (HD), peritoneal dialysis (PD) and peritoneal ultrafiltration (PUF) are potential therapeutic options in diuretic-resistant states. This systematic review assessed outcomes of PD and compared the effects of PD to EC. A comprehensive search of major databases from 1966 to 2017 for studies utilising PD (or PUF) in diuretic-resistant HF was conducted, excluding studies involving patients with end-stage kidney disease. Data were extracted and combined using a random-effects model, expressed as odds ratio (OR). Thirty-one studies (n = 902) were identified from 3195 citations. None were randomised trials. Survival was variable (0-100%) with a wide follow-up duration (36 h-10 years). With follow-up > 1 year, the overall mortality was 48.3%. Only four studies compared PD with EC. Survival was 42.1% with PD and 45.0% with EC; the pooled effect did not favour either (OR 0.80; 95% confidence interval (CI): 0.24-2.69; p = 0.710). Studies on PD in patients with HF reported several benefits. Left ventricular ejection fraction (LVEF) improved after PD (OR 3.76, 95%CI: 2.24-5.27; p < 0.001). Seven of nine studies saw LVEF increase by > 10%. Twenty-one studies reported the New York Heart Association status and 40-100% of the patients improved by ≥ 1 grade. Nine of 10 studies reported reductions in hospitalisation frequency and/or duration. When treated with PD, HF patients had fewer symptoms, lower hospital admissions and duration compared to diuretic therapy. However, there is inadequate evidence comparing PD versus UF or HD. Further studies comparing these modalities in diuretic-resistant HF should be conducted.
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Affiliation(s)
- Chang Yin Chionh
- Department of Renal Medicine, Changi General Hospital, Singapore
| | - Anna Clementi
- Department of Nephrology and Dialysis, 220631Santa Marta e Santa Venera, Acireale, Italy
| | - Cheng Boon Poh
- Department of Renal Medicine, Changi General Hospital, Singapore
| | | | - Dinna N Cruz
- Division of Nephrology and Hypertension, Department of Medicine, 8784University of California San Diego, San Diego, CA, USA
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Wojtaszek E, Grzejszczak A, Niemczyk S, Malyszko J, Matuszkiewicz-Rowińska J. Peritoneal Ultrafiltration in the Long-Term Treatment of Chronic Heart Failure Refractory to Pharmacological Therapy. Front Physiol 2019; 10:310. [PMID: 31001127 PMCID: PMC6455052 DOI: 10.3389/fphys.2019.00310] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 03/07/2019] [Indexed: 12/25/2022] Open
Abstract
Introduction Despite continuous improvement in the treatment, heart failure (HF) is a growing health problem and a major cause of mortality and morbidity in the world. There is some positive experience with the removal of the fluid excess via peritoneum in those patients, regardless of their renal function. The aim of this single center pilot study was to assess the efficacy of peritoneal ultra filtration (PUF) with a nightly 12-h exchange in the long-term treatment of refractory HF. Methods The study included patients with chronic HF resistant to updated HF therapy (pharmacological and devices if applicable), who had experienced at least three hospitalizations due to HF during the preceding year and were disqualified from heart transplantation. All of them were treated with nightly 12-h 7.5% icodextrin exchange. Results There were 15 patients (13 men), aged 72 ± 9 years, with charlson comorbidity index (CCI) 9 ± 1.2, NYHA class IV (11 patients) or III (4 patients), and eGFR 32 ± 11 ml/min/1.73m2. They were followed up for 24 ± 8 months (range 12-43, median 26 months). During the 1st year, all patients improved their NYHA functional class from 3.7 ± 0.5 to 2.6 ± 0.5; P = 0.0005, with stable (34.3 ± 12.4, and 35.6 ± 16.5%, respectively) left ventricular ejection fraction (LVEF), and inferior vena cava (IVC) diameter decreased from 27.8 ± 2.7 to 24.4 ± 3.4 mm; P = 0.09. Daily diuresis increased from 867 ± 413 to 1221 ± 680 ml; P = 0.25, while the dose of furosemide could be reduced from 620 ± 256 to 360 ± 110 mg/d; P = 0.0005, however, the kidney function deteriorated, with eGFR drop from 32 ± 11 to 25.6 ± 13 ml/min/1.73m2; P = 0.01). HF-related hospitalizations decreased from 8.9 ± 2.8 days/month to 1.5 ± 1.2 days/month (P = 0.003). Mechanical peritoneal dialysis complications occurred in five patients and infectious complications in four (peritonitis rate 1 per 72 patient-month). Patient survival was 93% at 1 year and 73% at 2 year. Technique survival was 100%. Conclusion In patients with refractory HF, PUF with one overnight icodextrin exchange appears to be a promising therapeutic option as an adjunct to pharmacological management of those who are not transplant candidates. It should be emphasized that the treatment can have a great impact on the quality of life and the total costs of treating these patients.
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Affiliation(s)
- Ewa Wojtaszek
- Department of Nephrology, Dialysis and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Agnieszka Grzejszczak
- Department of Nephrology, Dialysis and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Stanislaw Niemczyk
- Department of Nephrology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
| | - Jolanta Malyszko
- Department of Nephrology, Dialysis and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
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Wong J, Vilar E, Davenport A, Farrington K. Incremental haemodialysis. Nephrol Dial Transplant 2015; 30:1639-48. [DOI: 10.1093/ndt/gfv231] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Accepted: 04/21/2015] [Indexed: 12/15/2022] Open
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Lu R, Muciño-Bermejo MJ, Ribeiro LC, Tonini E, Estremadoyro C, Samoni S, Sharma A, Zaragoza Galván JDJ, Crepaldi C, Brendolan A, Ni Z, Rosner MH, Ronco C. Peritoneal dialysis in patients with refractory congestive heart failure: a systematic review. Cardiorenal Med 2015; 5:145-56. [PMID: 25999963 PMCID: PMC4427136 DOI: 10.1159/000380915] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Refractory congestive heart failure (RCHF) is associated with a high mortality rate and is a major contributor to hospital admissions. Peritoneal dialysis (PD) is an option to control volume overload and perhaps improve outcomes in this challenging patient population. The aim of this systematic review is to describe the relative risk-benefit ratio based on data reported regarding the use of PD in RCHF. This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. An electronic search of PubMed, Embase, and the Cochrane Library was performed to identify relevant studies published from January 1951 to February 2014. Eligible studies selected were prospective or retrospective adult population studies on PD in the setting of RCHF. The following clinical outcomes were used to assess PD therapy: (1) hospitalization rates; (2) heart function; (3) renal function; (4) fluid overload, and (5) adverse clinical outcomes. SUMMARY Of 864 citations, we excluded 843 citations and included 21 studies (n = 673 patients). After PD, hospitalization days declined significantly (p = 0.0001), and heart function improved significantly (left ventricular ejection fraction: p = 0.0013; New York Heart Association classification: p = 0.0000). There were no statistically significant differences in glomerular filtration rate after PD treatment in non-chronic kidney disease stage 5D patients (p = 0.1065). Among patients treated with PD, body weight decreased significantly (p = 0.0006). The yearly average peritonitis rate was 14.5%, and the average yearly mortality was 20.3%. KEY MESSAGES This systematic review suggests that PD may be an effective and safe therapeutic tool for patients with RCHF.
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Affiliation(s)
- Renhua Lu
- Department of Nephrology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Nephrology, Dialysis and Transplantation of the San Bortolo Hospital, International Renal Research Institute of Vicenza, Vicenza, Italy
| | - María-Jimena Muciño-Bermejo
- Nephrology, Dialysis and Transplantation of the San Bortolo Hospital, International Renal Research Institute of Vicenza, Vicenza, Italy
| | - Leonardo Claudino Ribeiro
- Nephrology, Dialysis and Transplantation of the San Bortolo Hospital, International Renal Research Institute of Vicenza, Vicenza, Italy
| | - Enrico Tonini
- Nephrology, Dialysis and Transplantation of the San Bortolo Hospital, International Renal Research Institute of Vicenza, Vicenza, Italy
| | - Carla Estremadoyro
- Nephrology, Dialysis and Transplantation of the San Bortolo Hospital, International Renal Research Institute of Vicenza, Vicenza, Italy
| | - Sara Samoni
- Nephrology, Dialysis and Transplantation of the San Bortolo Hospital, International Renal Research Institute of Vicenza, Vicenza, Italy
| | - Aashish Sharma
- Nephrology, Dialysis and Transplantation of the San Bortolo Hospital, International Renal Research Institute of Vicenza, Vicenza, Italy
| | - José de Jesús Zaragoza Galván
- Nephrology, Dialysis and Transplantation of the San Bortolo Hospital, International Renal Research Institute of Vicenza, Vicenza, Italy
| | - Carlo Crepaldi
- Nephrology, Dialysis and Transplantation of the San Bortolo Hospital, International Renal Research Institute of Vicenza, Vicenza, Italy
| | - Alessandra Brendolan
- Nephrology, Dialysis and Transplantation of the San Bortolo Hospital, International Renal Research Institute of Vicenza, Vicenza, Italy
| | - Zhaohui Ni
- Department of Nephrology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Mitchell H. Rosner
- Division of Nephrology, University of Virginia Health System, Charlottesville, Va., USA
| | - Claudio Ronco
- Nephrology, Dialysis and Transplantation of the San Bortolo Hospital, International Renal Research Institute of Vicenza, Vicenza, Italy
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Peritoneal ultrafiltration in congestive heart failure—findings reported from its application in clinical practice: a systematic review. J Nephrol 2015; 28:29-38. [DOI: 10.1007/s40620-014-0166-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 12/05/2014] [Indexed: 11/26/2022]
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Davies S, Lally F, Satchithananda D, Kadam U, Roffe C. Extending the role of peritoneal dialysis: can we win hearts and minds? Nephrol Dial Transplant 2014; 29:1648-54. [DOI: 10.1093/ndt/gfu001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Current world literature. Curr Opin Cardiol 2013; 28:259-68. [PMID: 23381096 DOI: 10.1097/hco.0b013e32835ec472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Cortical sources of EEG rhythms in congestive heart failure and Alzheimer's disease. Int J Psychophysiol 2012; 86:98-107. [PMID: 22771500 DOI: 10.1016/j.ijpsycho.2012.06.053] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Revised: 06/14/2012] [Accepted: 06/29/2012] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The brain needs continuous oxygen supply even in resting-state. Hypoxia enhances resting-state electroencephalographic (EEG) rhythms in the delta range, and reduces those in the alpha range, with a pattern similar to that observed in Alzheimer's disease (AD). Here we tested whether resting-state cortical EEG rhythms in patients with congestive heart failure (CHF), as a model of acute hypoxia, present frequency similarities with AD patients, comparable by cognitive status revealed by the mini mental state examination (MMSE). METHODS Eyes-closed EEG data were recorded in 10 CHF patients, 20 AD patients, and 20 healthy elderly subjects (Nold) as controls. LORETA software estimated cortical EEG generators. RESULTS Compared to Nold, both AD and CHF groups presented higher delta (2-4Hz) and lower alpha (8-13Hz) temporal sources. The highest delta and lowest alpha sources were observed in CHF subjects. In these subjects, the global amplitude of delta sources correlated with brain natriuretic peptide (BNP) level in the blood, as a marker of disease severity. CONCLUSIONS Resting-state delta and alpha rhythms suggest analogies between the effects of acute hypoxia and AD neurodegeneration on the cortical neurons' synchronization. SIGNIFICANCE Acute ischemic hypoxia could affect the mechanisms of cortical neural synchronization generating resting state EEG rhythms, inducing the "slowing" of EEG rhythms typically observed in AD patients.
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Ross EA, Kazory A. Ultrafiltration Therapy for Cardiorenal Syndrome: Physiologic Basis and Contemporary Options. Blood Purif 2012; 34:149-57. [DOI: 10.1159/000342080] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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