Twelve elderly CKD patients (stages 3–5) with refractory HF [New York Heart Association (NYHA) class III, n = 9; IV, n = 3; mean age, 81 ± 6 years] received PD treatment. Patients had episodes of >3 hospitalizations in the previous year, and were initially treated with ≤19 sessions of sequential hemofiltration, followed by incremental PD, with 3 PD sessions/week (8 h each) at the start, increasing in frequency and dwelling time as clinically indicated.
During follow-up (median, 26.5 months), PD was well tolerated by all patients, and no patients required hospitalization for HF. Three patients died due to non-HF-related events. All patients showed improvements in NYHA functional class (class I, n = 9; class II, n = 3) and significant decreases in the dose of diuretics prescribed (P < 0.05). Kidney function stabilized, while significant improvements in end-diastolic left ventricular diameter (−5 % , P < 0.05) and hemoglobin count (+15 % , P < 0.05) were achieved. Brain natriuretic peptide (−46 % ) and aldosterone (−13 % ) levels tended to decrease.
Incremental PD could represent a novel therapeutic option for elderly patients with refractory HF. In addition to fluid removal by PD, correction of renal anemia, preservation of kidney function, and avoidance of high-dose diuretic therapy may play a role in maximizing clinical benefits.