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首页> 外文期刊>Journal of nephrology. >Peritoneal ultrafiltration in patients with advanced decompensated heart failure
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Peritoneal ultrafiltration in patients with advanced decompensated heart failure

机译：晚期失代偿性心力衰竭患者的腹膜超滤

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摘要

The aim of the Best Practice guidelines on peritoneal ultrafiltration (UF) in patients with treatment-resistant advanced decompensated heart failure (TR-AHDF) is to achieve a common approach to the management of decompensated heart failure in those situations in which all conventional treatment options have been unsuccessful, and to stimulate a closer cooperation between nephrologists and cardiologists. The standardization of the case series of different centers would allow a better definition of the results published in the literature, without which they are nothing more than anecdotes. TR-AHDF is characterized by the persistence of severe symptoms even when all possible pharmacological and surgical options have been exhausted. These patients are often treated with methods that allow extracorporeal UF - slow continuous ultrafiltration (SCUF) and continuous renal replacement therapy (CRRT) - which have to be performed in hospital facilities. Peritoneal ultrafiltration (PUF) can be considered a treatment option in patients with TR - AHDF when, despite the fact that all treatment options have been used, patients meet the following criteria: ? stage D decompensated heart failure (ACC/AHA classification); ? INTERMACS level 4 decompensated heart failure; ? INTERMACS frequent flyer profile; ? chronic renal failure (estimated glomerular filtration rate 50 ml/min per 1.73 m2: KDOQI classification stage 3 chronic kidney disease); ? no obvious contraindications to peritoneal UF. PUF treatment modes are derived from the treatment regimens proposed by various authors to obtain systemic UF in patients with severe decompensated heart failure, using manual and automated incremental peritoneal dialysis involving various glucose concentrations in addition to the single icodextrin exchange. These guidelines also identify a minimum set of tests and procedures for the follow-up phase, to be supplemented, according to the center's resources and policy, with other tests that are less routine or more complex also from a logistic/organizational standpoint, emphasizing the need for the patient's clinical and treatment program to involve both the nephrologist and the cardiologist. The pathophysiological aspects of a deterioration in kidney function in patients with decompensated heart failure are also considered, and the results of PUF in patients with decompensated heart failure reported in the various case series are reviewed.
机译：难治性晚期失代偿性心力衰竭（TR-AHDF）患者腹膜超滤（UF）最佳实践指南的目标是，在所有常规治疗方案均能解决的情况下，实现一种通用的方法来处理失代偿性心力衰竭一直没有成功，并激发了肾脏科医生和心脏病专家之间的紧密合作。对不同中心的案例系列进行标准化，可以更好地定义文献中发表的结果，没有这些，无非是轶事。 TR-AHDF的特征是即使在所有可能的药理和手术选择都已用尽的情况下，仍然存在严重症状。这些患者通常接受允许在医院设施中进行体外超滤的方法-慢速连续超滤（SCUF）和连续肾脏替代疗法（CRRT）。尽管已使用所有治疗方案，但患者符合以下标准，但腹膜超滤（PUF）可被视为TR-AHDF患者的治疗方案： D期失代偿性心力衰竭（ACC / AHA分类）; ？ INTERMACS 4级失代偿性心力衰竭; ？ INTERMACS飞行常客简介; ？慢性肾功能衰竭（估计的肾小球滤过率<50 ml / min / 1.73 m2：KDOQI分类第3期慢性肾脏病）; ？腹膜超滤无明显禁忌症。 PUF治疗模式源自多位作者提出的治疗方案，旨在通过严重的失代偿性心力衰竭患者使用手动和自动腹膜透析，除了单次艾考糊精交换外，还使用各种葡萄糖浓度，以获得全身性UF。这些指南还确定了后续阶段的最低限度的测试和程序集，根据中心的资源和政策，从后勤/组织的角度来看，这些测试和例行程序的例行性或更差一些，从物流/组织的角度来看，也应予以补充。病人的临床和治疗计划需要肾脏科医生和心脏病专家共同参与。还考虑了失代偿性心力衰竭患者肾功能恶化的病理生理方面，并回顾了各种病例系列中报道的失代偿性心力衰竭患者PUF的结果。

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