腹膜和尿钠去除难治性充血性心力衰竭患者包括在一个动态腹膜透析计划:有价值的监测疾病的进程。

IF 2.4 4区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Cardiorenal Medicine Pub Date : 2023-01-01 Epub Date: 2023-08-16 DOI:10.1159/000531631
Gema Miñana, Miguel González-Rico, Rafael de la Espriella, Daniel González-Sánchez, Marco Montomoli, Eduardo Núñez, Agustín Fernández-Cisnal, Sandra Villar, Jose Luis Górriz, Julio Núñez
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引用次数: 0

摘要

简介:尿钠点作为评估充血性心力衰竭(CHF)患者去充血的有用参数出现。越来越多的证据支持持续动态腹膜透析(CAPD)在难治性CHF和肾脏疾病患者中的治疗作用。我们的目的是研究一组参加CAPD项目的难治性CHF患者的尿、腹膜和总(尿加腹膜)钠去除的长期轨迹。此外,我们还探讨了钠去除是否与长期死亡率和心力衰竭恶化(WHF)发作的风险相关。方法:我们纳入了66例难治性慢性心力衰竭的门诊患者,他们参加了一个单一教学中心的CAPD项目。在基线和CAPD开始后分析24小时腹膜、尿液和总钠消除。使用纵向和生存数据的联合建模来计算其随时间的轨迹。在复发性和终末期事件的联合衰弱模型框架内,我们估计了其对WHF复发发作的预后影响。结果:入组时,平均年龄为72.8±8.4岁,肾小球滤过率为28.5±14.3 mL/min/1.73 m2。基线时尿钠中位数为2.34 g/d(1.40-3.55)。在2.93(1.93-3.72)年的中位随访(p25%-p75%)中,我们记录到每1人年0.28例死亡和0.24例WHF发作。与基线(尿)相比,自第一次随访以来,CAPD导致钠排泄(尿加透析)增加(p <0.001)。在随访中,反复测量总钠去除量与较低的死亡和WHF发作风险相关。结论:CAPD增加了难治性CHF患者的钠清除。钠去除量升高确定了那些死亡和WHF发作风险较低的患者。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Peritoneal and Urinary Sodium Removal in Refractory Congestive Heart Failure Patients Included in an Ambulatory Peritoneal Dialysis Program: Valuable for Monitoring the Course of the Disease.

Introduction: Spot urinary sodium emerged as a useful parameter for assessing decongestion in patients with congestive heart failure (CHF). Growing evidence endorses the therapeutic role of continuous ambulatory peritoneal dialysis (CAPD) in patients with refractory CHF and kidney disease. We aimed to examine the long-term trajectory of urinary, peritoneal, and total (urinary plus peritoneal) sodium removal in a cohort of patients with refractory CHF enrolled in a CAPD program. Additionally, we explored whether sodium removal was associated with the risk of long-term mortality and episodes of worsening heart failure (WHF).

Methods: We included 66 ambulatory patients with refractory CHF enrolled in a CAPD program in a single teaching center. 24-h peritoneal, urinary, and total sodium elimination were analyzed at baseline and after CAPD initiation. Its trajectories over time were calculated using joint modeling of longitudinal and survival data. Within the framework of joint frailty models for recurrent and terminal events, we estimated its prognostic effect on recurrent episodes of WHF.

Results: At the time of enrollment, the mean age and estimated glomerular filtration rate were 72.8 ± 8.4 years and 28.5 ± 14.3 mL/min/1.73 m2, respectively. The median urinary sodium at baseline was 2.34 g/day (1.40-3.55). At a median (p25%-p75%) follow-up of 2.93 (1.93-3.72) years, we registered 0.28 deaths and 0.24 episodes of WHF per 1 person-year. Compared to baseline (urinary), CAPD led to increased sodium excretion (urinary plus dialyzed) since the first follow-up visit (p < 0.001). Over the follow-up, repeated measurements of total sodium removal were associated with a lower risk of death and episodes of WHF.

Conclusions: CAPD increased sodium removal in patients with refractory CHF. Elevated sodium removal identified those patients with a lower risk of death and episodes of WHF.

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来源期刊
Cardiorenal Medicine
Cardiorenal Medicine CARDIAC & CARDIOVASCULAR SYSTEMS-UROLOGY & NEPHROLOGY
CiteScore
5.40
自引率
2.60%
发文量
25
审稿时长
>12 weeks
期刊介绍: The journal ''Cardiorenal Medicine'' explores the mechanisms by which obesity and other metabolic abnormalities promote the pathogenesis and progression of heart and kidney disease (cardiorenal metabolic syndrome). It provides an interdisciplinary platform for the advancement of research and clinical practice, focussing on translational issues.
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