IMPROVED RENAL-FUNCTION FOLLOWING ACUTE PERITONEAL-DIALYSIS IN PATIENTS WITH INTRACTABLE CONGESTIVE-HEART-FAILURE

  • 1 July 1987
    • journal article
    • research article
    • Vol. 23  (7) , 821-824
Abstract
Nine patients, six men and three women, 40 to 73 years of age, were included in the study. All of the patients had severe heart failure refractory to aggressive therapy including digitalis, diuretics, and vasodilators. Eight patients underwent one treatment of peritoneal dialysis while the remaining patients received two dialyses. The urine output was measured by an indwelling catheter; glomerular filtration rate (GFR) was determined by creatinine and inulin clearance, and renal blood flow (RBF) was determined by sodium paraamino hippurate (PAH) clearance. Following one peritoneal dialysis, the mean fluid loss/patient was 3,995 ml (range 3,200 to 5,100 ml). Dialysis was generally well tolerated. One patient, who had underlying hepatic cirrhosis and underwent two dialyses, developed hepatic failure and died 10 days after the second dialysis. At postmortem, peritonitis was discovered. All of the patients showed a marked subjective and objective clinical improvement. The mean plasma urea decreased from 154 to 41 mg/dl (P < 0.005), and mean plasma creatinine decreased from 1.83 to 1.13 mg/dl (P > 0.005). Blood pH was 4.30 before dialysis and increased to 7.37 (P < 0.0125) after treatment. Mean urine output predialysis was 955 ml and increased to 1,472 ml post dialysis (P < 0.0005). Creatinine clearance increased from 35 to 73 ml/min (P < 0.0005). The mean inulin clearance increased from 33/min predialysis to 69 ml/min post dialysis (P < 0.005), and mean PAH clearance increased from 96.7 to 362.5 ml/min (P < 0.0005). Acute peritoneal dialysis is a safe and effective means for removing large quantities of excess fluid from patients with intractable heart failure.

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