Practice and Outcome Trends of Peritoneal Dialysis in Chronic Kidney Disease Patients With Liver Cirrhosis and Chronic Heart Failure Complicated by Symptomatic Ascites-A Scoping Review.

IF 2.4 4区 医学 Q2 UROLOGY & NEPHROLOGY
Nephrology Pub Date : 2025-03-01 DOI:10.1111/nep.70013
Claude J Renaud, Tricia Mae Wong, Muhamed Shamir Jaffar Hussein
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引用次数: 0

Abstract

Background: The rising growth of patients with end-stage kidney disease (ESKD) associated with chronic liver disease (CLD) and refractory chronic heart failure (CHF) associated with advanced chronic kidney disease (CKD) complicated by ascites presents serious renal replacement therapy (RRT) challenges. Haemodialysis is often poorly tolerated owing to increased hemodynamic instability, bleeding, and encephalopathy risks. Peritoneal dialysis (PD) has emerged as a promising alternative, but its adoption and efficacy are not consistently supported by existing literature, and there lacks guideline consensus.

Methods: We thus used a scoping review approach to more accurately map the literature on PD practice and outcomes in this population.

Results: We identified 18 observational studies involving 627 ESKD patients with CLD/ascites and 222 advanced CKD patients with CHF/ascites. We found practice patterns revealing higher adoption of PD for CLD/ascites in Asia, reflecting the heavier regional PD and viral hepatitis penetration, while there was unique usage for CHF in Western settings. Across contexts, PD demonstrated adaptability for diverse patient profiles. PD as urgent-start and incremental therapy enabled both long-term controlled paracentesis and dialysis while maintaining haemodynamic stability, optimal nutritional status and particularly in CHF improved symptom control, reduced hospitalisation, and lowered diuretics reliance. Mechanical complications were rare and typically manageable whilst peritonitis rates were comparable without impacting technique failure. Survival outcomes were also comparable or superior.

Conclusions: Our findings add valuable insights to PD as a feasible and safe long-term RRT option across the ascitic CKD spectrum. Broader consensus is nonetheless needed on its expansion as a first-line therapy and bridge to both palliation and transplantation.

腹膜透析治疗慢性肾病合并肝硬化和慢性心力衰竭并发症状性腹水的实践和结果趋势——范围综述
背景:与慢性肝脏疾病(CLD)相关的终末期肾脏疾病(ESKD)和与晚期慢性肾脏疾病(CKD)合并腹水的难治性慢性心力衰竭(CHF)患者的增长给肾脏替代治疗(RRT)带来了严峻的挑战。由于血流动力学不稳定、出血和脑病风险增加,血液透析通常耐受性差。腹膜透析(PD)已成为一种很有前景的替代方案,但其采用和疗效并没有得到现有文献的一致支持,也缺乏指导共识。方法:因此,我们使用范围审查方法来更准确地绘制PD实践和结果在这一人群的文献。结果:我们纳入了18项观察性研究,涉及627例ESKD合并CLD/腹水患者和222例晚期CKD合并CHF/腹水患者。我们发现实践模式显示,在亚洲,PD治疗CLD/腹水的使用率更高,这反映了更重的区域性PD和病毒性肝炎的渗透,而在西方,CHF的使用是独特的。在各种情况下,PD表现出对不同患者概况的适应性。PD作为紧急启动和增量治疗,在维持血流动力学稳定和最佳营养状态的同时,能够长期控制穿刺和透析,特别是在CHF中,改善了症状控制,减少了住院治疗,降低了对利尿剂的依赖。机械并发症是罕见的,通常是可控的,而腹膜炎的发生率相当,没有影响技术失败。生存结果也相当或更好。结论:我们的研究结果为PD作为一种可行且安全的长期RRT选择在腹水性CKD谱系中提供了有价值的见解。尽管如此,在将其扩展为一线治疗以及缓解和移植的桥梁方面,仍需要更广泛的共识。
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来源期刊
Nephrology
Nephrology 医学-泌尿学与肾脏学
CiteScore
4.50
自引率
4.00%
发文量
128
审稿时长
4-8 weeks
期刊介绍: Nephrology is published eight times per year by the Asian Pacific Society of Nephrology. It has a special emphasis on the needs of Clinical Nephrologists and those in developing countries. The journal publishes reviews and papers of international interest describing original research concerned with clinical and experimental aspects of nephrology.
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