Successful treatment with assisted automated peritoneal dialysis using 4.25% glucose dialysate for an elderly patient wi
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CASE REPORT
Successful treatment with assisted automated peritoneal dialysis using 4.25% glucose dialysate for an elderly patient with refractory heart failure Naohiro Toda1,2 · Ryosuke Iwaki1 · Kaori Oishi1 · Yuichi Takasu1 · Toshiyuki Komiya1,2 Received: 25 May 2020 / Accepted: 4 September 2020 © Japanese Society of Nephrology 2020
Abstract Refractory heart failure is a major cause of mortality and hospitalization, and peritoneal dialysis (PD) is one of the options for controlling volume overload. Although high glucose dialysate enables a large amount of ultrafiltration, the use of 4.25% glucose dialysate is generally avoided, because high glucose exposure leads to peritoneal damage. Here, we describe a patient who was successfully treated with assisted automated PD using 4.25% glucose dialysate for refractory heart failure. An 84-year-old woman developed heart failure due to severe mitral regurgitation with a low left-ventricular ejection fraction of 30%, and also developed progressive kidney deterioration. She had been refractory to diuretics and repeatedly hospitalized. PD was started to treat refractory heart failure. Since it was difficult for her to change the dialysis bags by herself, assistance with her PD from her family was needed. The use of 4.25% glucose dialysate markedly increased ultrafiltration and improved her condition. In addition, automated PD (APD) using 4.25% glucose dialysate enabled her family to have a break from PD once every 4 days. Thereafter, she had no episodes of hospitalization due to heart failure for approximately 18 months after her discharge. Keywords Refractory heart failure · Assisted peritoneal dialysis · 4.25% glucose dialysate
Introduction Refractory heart failure is a major cause of mortality and hospitalization that incurs high healthcare costs. The incidence of heart failure was estimated at 5–9% for those aged 65 years and over [1]. Diuretic resistance is a frequent problem and is a powerful predictor of poor outcome in acute heart failure. Diuretic resistance is more frequent in cases of underlying chronic kidney disease [2]. An alternative strategy in refractory heart failure is ultrafiltration such as hemodialysis, continuous renal replacement therapy (CRRT), and peritoneal dialysis (PD). The advantages of PD for heart failure are its continuous nature and a greater physiological removal of extracellular * Naohiro Toda [email protected]‑u.ac.jp 1
Department of Nephrology, Kansai Electric Power Hospital, 2‑1‑7, Fukushim, Fukushima‑ku 54, Osaka 553‑0003, Japan
Division of Renal Disease and Blood Purification, Kansai Electric Power Medical Research Institute, Kobe, Japan
2
fluid with stable hemodynamics. A previous systematic review suggested that PD might be an effective therapeutic option for improving cardiac function and weight control in patients with refractory congestive heart failure [3]. Although high glucose dialysate enables a large amount of ultrafiltration [4], the use of 4.25% glucose dialysate has been avoided, because high glucose exposu
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