切换至 "中华医学电子期刊资源库"

中华肾病研究电子杂志 ›› 2014, Vol. 03 ›› Issue (03) : 155 -159. doi: 10.3877/cma.j.issn.2095-3216.2014.03.009

综述

腹膜透析对Ⅰ、Ⅱ型心肾综合征治疗作用的研究进展
李舒1, 倪兆慧1,()   
  1. 1.200127 上海交通大学医学院附属仁济医院肾内科
  • 出版日期:2014-06-15
  • 通信作者: 倪兆慧
  • 基金资助:
    国家自然科学基金(81070548,81370794)十二五国家科技支撑计划(2011BAI10B08)

Progress of research on the role of peritoneal dialysis in treatment of cardiorenal syndrome type Ⅰ and Ⅱ

Shu Li1, Zhaohui Ni1,()   

  1. 1.Department of Nephrology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
  • Published:2014-06-15
  • Corresponding author: Zhaohui Ni
引用本文:

李舒, 倪兆慧. 腹膜透析对Ⅰ、Ⅱ型心肾综合征治疗作用的研究进展[J/OL]. 中华肾病研究电子杂志, 2014, 03(03): 155-159.

Shu Li, Zhaohui Ni. Progress of research on the role of peritoneal dialysis in treatment of cardiorenal syndrome type Ⅰ and Ⅱ[J/OL]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2014, 03(03): 155-159.

心肾综合征(CRS)是一种心脏和肾脏功能障碍并存的复杂疾病,发病率高,治疗方案复杂。 在缓解Ⅰ、Ⅱ型心肾综合征患者的充血性心衰症状方面,传统的治疗方案主要为利尿剂治疗和血液超滤,但这两种方案都存在一定的不足之处。 近年来,多项研究显示腹膜透析在治疗Ⅰ、Ⅱ型心肾综合征时,能够纠正患者容量负荷过重,改善心功能,减少再住院率,也是一种有效的治疗方法。 本文主要就最近国际上有关腹膜透析在Ⅰ、Ⅱ心肾综合征中的治疗效果、作用机制和可行性研究进展作一综述。

Cardiorenal syndrome (CRS) is defined as a complex pathophysiological disorder manifested by both cardiac and renal dysfunctions with a high mobidity and a very complicated therapy. To alleviate the symptoms of congestive heart failure in patients with CRS type Ⅰand Ⅱ, diuretics and ultrafiltration are usually used in traditional therapy, although both of them have their limitations. In recent years, accumulating studies have indicated that peritoneal dialysis (PD) is an effective therapy in fluid removal, cardiac function improvement, and hospitalization reduction of patients with CRS typeⅠand Ⅱ.The present review mainly introduces the results of recent studies of PD therapy in CRS typeⅠandⅡ,with an emphasis on the efficacy, underlying mechanisms, and feasibility of PD.

表1 腹膜透析治疗心力衰竭的队列研究荟萃分析结果[35]
作者 人数 生存 住院 功能改善情况
Nakayama等[24] 12(PD) 中位随访时间26个月,生存率为75% >3次/年(PD之前),PD之后无因心衰住院 NYHA分级从Ⅲ级(n=9)、Ⅳ级(n=3)降为Ⅰ级(n=9)、Ⅱ级(n=3)
Sotirakopoulos等[26] 19(PD) 1年生存率为68%,2年生存率为42% 因液体潴留住院时间PD之前为5~20d/(月·人),PD之后为0 平均射血分数从28%升高到36%,体重下降5kg
Cnossen等[27-28] 12(PD) 中位生存期为16个月 心脏疾病相关住院时间从1.4降为0.4d/(月·人) NYHA分级从3.8降为2.7,生活质量改善,但机械并发症增多(HD=PD)
11(HD)
Nunez等[25,30] 28(PD) PD降低了死亡风险:0.4(0.21~0.75) 开始PD6个月内84%的患者住院率减少 16个月总死亡率为63%,25例患者MLWHF评分、6分钟步行实验和NYHA分级改善(平均为1.04)
12(对照)
Kunin等[29] 37(PD) 中位生存期为14个月 “长期”生存患者住院率下降55% “长期”生存患者需要使用的利尿剂减少,NYHA分级平均下降1级
Rizkallah等[31] 10(PD) ? 住院时间从3.2d/(人·月)降为0.1d/(人·月),每次住院时间从37d降为0.78d 无法耐受移植。NYHA分级ⅢB级者心功能改善,对利尿剂的反应增强,体重下降7kg
Courivaud等[32] 126(PD) 1年生存率为58% 住院时间从3.3d/(人·月)降为0.3d/(人·月) 左室射血分数增加
Bertoli等[33] 48(PD) 1年生存率为85%,2年生存率为56% 年入院次数从43次降为11次 PD之前1年需要入院进行体外超滤治疗至少3次,PD之后无
1
Hebert K,Dias A,Delgado MC,et al. Epidemiology and survival of the five stages of chronic kidney disease in a systolic heart failure population [J]. Eur J Heart Fail,2010,12(8):861-865.
2
Go AS, Mozaffarian D, Roger VL, et al. Heart disease and stroke statistics--2013 update: a report from the American Heart Association [J]. Circulation,2013,127(1): e6-e245.
3
Heywood JT, Fonarow GC, Costanzo MR, et al. High prevalence of renal dysfunction and its impact on outcome in 118 465 patients hospitalized with acute decompensated heart failure:a report from the ADHERE database [J]. J Card Fail,2007,13(6):422-430.
4
Iyngkaran P, Thomas M, Majoni W, et al. Comorbid heart failure and renal impairment: epidemiology and management [ J].Cardiorenal Med,2012,2(4):281-297.
5
RoncoC, Mccullough P, Anker SD, et al. Cardio-renal syndromes:report from the consensus conference of the acute dialysis quality initiative [J]. Eur Heart J,2010,31(6):703-711.
6
Ronco C, Haapio M, House AA, et al. Cardiorenal syndrome [J].J Am Coll Cardiol,2008,52(19):1527-1539.
7
Bock JS,Gottlieb SS. Cardiorenal syndrome:new perspectives[J].Circulation,2010,121(23):2592-2600.
8
Guazzi M, Gatto P, Giusti G, et al. Pathophysiology of cardiorenal syndrome in decompensated heart failure: role of lung-right heartkidney interaction [J]. Int J Cardiol,2013,169(6):379-384.
9
Sarraf M, Schrier RW. Cardiorenal syndrome in acute heart failure syndromes [J]. Int J Nephrol,2011,2011:293938.
10
Sarraf M, Masoumi A, Schrier RW. Cardiorenal syndrome in acute decompensated heart failure [J]. Clin J Am Soc Nephrol, 2009, 4(12):2013-2026.
11
Nohria A, Hasselblad V, Stebbins A, et al. Cardiorenal interactions: insights from the ESCAPE trial [J]. J Am Coll Cardiol,2008,51(13):1268-1274.
12
Mullens W, Abrahams Z, Francis GS, et al. Importance of venous congestion for worsening of renal function in advanced decompensated heart failure [J]. J Am Coll Cardiol,2009,53(7):589-596.
13
Schrier RW. Blood urea nitrogen and serum creatinine: not married in heart failure [J]. Circ Heart Fail,2008,1(1):2-5.
14
Guglin M, Rivero A, Matar F, et al. Renal dysfunction in heart failure is due to congestion but not low output [J]. Clin Cardiol,2011,34(2):113-116.
15
Nakayama M. Nonuremic indication for peritoneal dialysis for refractory heart failure in cardiorenal syndrome type II: review and perspective [J]. Perit Dial Int,2013,33(1):8-14.
16
Felker GM, Lee KL, Bull DA, et al. Diuretic strategies in patients with acute decompensated heart failure [J]. N Engl J Med, 2011,364(9):797-805.
17
Shah RV, Mcnulty S, O'connor CM, et al. Effect of admission oral diuretic dose on response to continuous versus bolus intravenous diuretics in acute heart failure: an analysis from diuretic optimization strategies in acute heart failure [J]. Am Heart J, 2012, 164(6):862-868.
18
Butler J, Forman DE, Abraham WT, et al. Relationship between heart failure treatment and development of worsening renal function among hospitalized patients [J]. Am Heart J,2004,147(2):331-338.
19
Costanzo MR,Guglin ME,Saltzberg MT,et al. Ultrafiltration versus intravenous diuretics for patients hospitalized for acute decompensated heart failure[J]. J Am Coll Cardiol,2007,49(6):675-683.
20
Marenzi G, Lauri G, Grazi M, et al. Circulatory response to fluid overload removal by extracorporeal ultrafiltration in refractory congestive heart failure [J]. J Am Coll Cardiol, 2001, 38(4):963-968.
21
Jaski BE,Ha J,Denys BG,et al. Peripherally inserted veno-venous ultrafiltration for rapid treatment of volume overloaded patients [J].J Card Fail,2003,9(3):227-231.
22
Bart BA, Goldsmith SR, Lee KL, et al. Ultrafiltration in decompensated heart failure with cardiorenal syndrome [J]. N Engl J Med,2012,367(24):2296-2304.
23
Mehrotra R, Kathuria P. Place of peritoneal dialysis in the management of treatment-resistant congestive heart failure [J].Kidney Int,2006,70(Suppl 103): S67-S71.
24
Nakayama M,Nakano H,Nakayama M. Novel therapeutic option for refractory heart failure in elderly patients with chronic kidney disease by incremental peritoneal dialysis [J]. J Cardiol, 2010, 55(1):49-54.
25
Nunez J, Gonzalez M, Minana G, et al. Continuous ambulatory peritoneal dialysis as a therapeutic alternative in patients with advanced congestive heart failure [J]. Eur J Heart Fail, 2012, 14(5):540-548.
26
Sotirakopoulos NG, Kalogiannidou IM, Tersi ME, et al. Peritoneal dialysis for patients suffering from severe heart failure [J]. Clin Nephrol,2011,76(2):124-129.
27
Cnossen TT, Kooman JP, Konings CJ, et al. Peritoneal dialysis in patients with primary cardiac failure complicated by renal failure[J]. Blood Purif,2010,30(2):146-152.
28
Cnossen TT, Kooman JP, Krepel HP, et al. Prospective study on clinical effects of renal replacement therapy in treatment-resistant congestive heart failure [J]. Nephrol Dial Transplant, 2012, 27(7):2794-2799.
29
Kunin M, Arad M, Dinour D, et al. Peritoneal dialysis in patients with refractory congestive heart failure: potential prognostic factors[J]. Blood Purif,2013,35(4):285-294.
30
Nunez J, Gonzalez M, Minana G, et al. Continuous ambulatory peritoneal dialysis and clinical outcomes in patients with refractory congestive heart failure [J]. Rev Esp Cardiol (Engl Ed),2012,65(11):986-995.
31
Rizkallah J,Sood MM,Reslerova M,et al. Reduced hospitalizations in severe, refractory congestive heart failure with peritoneal dialysis:a consecutive case series [J]. Clin Nephrol, 2013, 80(5): 334-341.
32
Courivaud C, Kazory A, Crepin T, et al. Peritoneal dialysis reduces the number of hospitalization days in heart failure patients refractory to diuretics [J]. Perit Dial Int,2014,34(1):100-108.
33
Bertoli SV, Musetti C, Ciurlino D, et al. Peritoneal ultrafiltration in refractory heart failure:a cohort study [J]. Perit Dial Int,2014,34(1):64-70.
34
Koch M, Haastert B, Kohnle M, et al. Peritoneal dialysis relieves clinical symptoms and is well tolerated in patients with refractory heart failure and chronic kidney disease [J]. Eur J Heart Fail,2012,14(5):530-539.
35
Davies S, Lally F, Satchithananda D, et al. Extending the role of peritoneal dialysis: can we win hearts and minds [J]? Nephrol Dial Transplant,2014, [Epub ahead of print]
36
Gotloib L, Fudin R, Yakubovich M, et al. Peritoneal dialysis in refractory end-stage congestive heart failure:a challenge facing a nowin situation [J]. Nephrol Dial Transplant, 2005, 20(Suppl 7):vii32-vii36.
37
Basile C, Chimienti D, Bruno A, et al. Efficacy of peritoneal dialysis with icodextrin in the long-term treatment of refractory congestive heart failure [J]. Perit Dial Int, 2009, 29(1): 116-118.
38
Ruhi C, Kocak H, Yavuz A, et al. Use of peritoneal ultrafiltration in the elderly refractory congestive heart failure patients [J]. Int Urol Nephrol,2012,44(3):963-969.
39
Nakayama M, Kasai K, Imai H, et al. Novel low Na peritoneal dialysis solutions designed to optimize Na gap of effluent: kinetics of Na and water removal [J]. Perit Dial Int,2009,29(5):528-535.
40
Ponce D, Berbel MN, Abrao JM, et al. A randomized clinical trial of high volume peritoneal dialysis versus extended daily hemodialysis for acute kidney injury patients [J]. Int Urol Nephrol, 2013, 45(3):869-878.
41
Gabriel DP,Caramori JT, Martim LC,et al. High volume peritoneal dialysis vs daily hemodialysis: a randomized, controlled trial in patients with acute kidney injury [J]. Kidney Int,2008,73(Suppl 108): S87-S93.
42
Chionh CY, Soni SS, Finkelstein FO, et al. Use of peritoneal dialysis in AKI: a systematic review [J]. Clin J Am Soc Nephrol,2013,8(10):1649-1660.
43
Mcintyre CW. Hemodynamic effects of peritoneal dialysis [J]. Perit Dial Int,2011,31(Suppl 2): S73-S76.
44
Prochnicka A, Krzesinski P, Halas K, et al. Diuretic-resistant congestive heart failure treated successfully with peritoneal ultrafiltration [J]. Kardiol Pol,2013,71(4):393-395.
45
Mcintyre CW. Update on peritoneal dialysis solutions [J]. Kidney Int,2007,71(6):486-490.
46
Rodriguez-Carmona A, Fontan MP. Sodium removal in patients undergoing CAPD and automated peritoneal dialysis [J]. Perit Dial Int,2002,22(6):705-713.
47
Flessner MF. Peritoneal ultrafiltration: mechanisms and measures[J]. Contrib Nephrol,2006,150:28-36.
48
Broekman KE, Sinkeler SJ, Waanders F, et al. Volume control in treatment-resistant congestive heart failure: role for peritoneal dialysis [J]. Heart Fail Rev,2014, [Epub ahead of print]
49
Lambie M, Chess J, Donovan KL, et al. Independent effects of systemic and peritoneal inflammation on peritoneal dialysis survival[J]. J Am Soc Nephrol,2013,24(12):2071-2080.
50
Silverberg DS, Wexler D, Blum M, et al. Effects of treatment with epoetin beta on outcomes in patients with anaemia and chronic heart failure [J]. Kidney Blood Press Res,2005,28(1):41-47.
[1] 郑庆发, 白建祥, 黄成文. 基于血小板和淋巴细胞计数比值的列线图模型预测腹膜透析相关腹膜炎患者治疗预后的价值[J/OL]. 中华实验和临床感染病杂志(电子版), 2023, 17(02): 117-124.
[2] 张亚龙, 邱涛, 刘一霆, 王天宇, 孔晨阳, 喻博, 周江桥. 术前透析方式及时长对肾移植预后的影响[J/OL]. 中华移植杂志(电子版), 2023, 17(02): 98-103.
[3] 王涛, 刘静, 高玉伟, 王兴华, 胡秀红, 崔红蕊, 徐保振, 杨洪娟. 抗生素耐药背景下中医药防治腹膜透析相关性腹膜炎研究进展[J/OL]. 中华肾病研究电子杂志, 2024, 13(06): 340-344.
[4] 崔文鹏. 腹膜透析在老年终末期肾脏疾病患者中的应用[J/OL]. 中华肾病研究电子杂志, 2024, 13(05): 300-300.
[5] 张晓青, 唐雯. 基于临床化验指标重新计算的生物标记物在预测腹膜透析患者预后中的作用研究进展[J/OL]. 中华肾病研究电子杂志, 2024, 13(04): 213-218.
[6] 李想, 王秀芬, 张涛, 李英. 腹膜透析的退出原因及其防治策略[J/OL]. 中华肾病研究电子杂志, 2023, 12(06): 329-333.
[7] 罗阳燕, 王少清, 高芳, 沈艳, 张万军, 李莉. 尿毒清颗粒对腹膜透析患者残余肾功能及腹透液纤连蛋白和TGF-β1水平的作用[J/OL]. 中华肾病研究电子杂志, 2023, 12(04): 200-204.
[8] 陈客宏. 干细胞外泌体防治腹膜透析腹膜纤维化新技术研究[J/OL]. 中华肾病研究电子杂志, 2023, 12(03): 180-180.
[9] 于梦园, 杨立明, 朱学研, 张晓暄, 刘声茂, 谢舜昀, 倪册, 庄小花, 崔文鹏. 肠源性腹膜透析相关性腹膜炎治疗失败的危险因素:多中心回顾性研究[J/OL]. 中华肾病研究电子杂志, 2023, 12(03): 127-133.
[10] 樊佩琦, 闫燕, 李晓霞, 武玲宇, 郭罡玲, 李静, 王利华. 2020年山西省腹膜透析患者贫血的流行病学调查及相关因素分析[J/OL]. 中华肾病研究电子杂志, 2023, 12(03): 121-126.
[11] 黎金秋, 韦晓芳, 王成玉. 腹膜透析相关性腹膜炎细菌谱变迁及药敏分析[J/OL]. 中华肾病研究电子杂志, 2022, 11(05): 264-269.
[12] 赵红亮, 崔炜. 1型心肾综合征的早期诊断及生物标志物研究进展[J/OL]. 中华肾病研究电子杂志, 2022, 11(02): 109-113.
[13] 蔡青利, 汪晓月, 蔡明玉, 王玲, 喻芳, 陈佳, 陈客宏, 何娅妮. 干细胞外泌体减轻高糖腹膜透析液诱导的腹膜炎症[J/OL]. 中华肾病研究电子杂志, 2021, 10(05): 252-258.
[14] 张赟辉, 罗军, 刘栗丽, 汪宏, 耿克明. 腹膜透析与血液透析对老年终末期肾病患者营养状况及炎症反应的影响[J/OL]. 中华临床医师杂志(电子版), 2023, 17(04): 419-423.
[15] 金莉, 刘丽, 金程, 郑多娟, 王娟. 基于IKAP理论的护理专案改善腹膜透析患者自我感受与期望水平[J/OL]. 中华临床医师杂志(电子版), 2022, 16(12): 1256-1261.
阅读次数
全文


摘要