CONTINUOUS AMBULATORY PERITONEAL-DIALYSIS FOR PATIENTS WITH SEVERE LEFT-VENTRICULAR SYSTOLIC DYSFUNCTION AND END-STAGE RENAL-DISEASE

To better define the survival and quality of life of patients with maj or left ventricular systolic dysfunction and end-stage renal disease t reated by continuous ambulatory peritoneal dialysis (CAPD), we reviewe d all cases who started CAPD between May 1984 and March 1993 who had a n isotopic left ventricular ejection fraction (LVEF) less than or equa l to 35%. Seventeen patients (12 men and five women with a mean age of 51.6 +/- 14.9 years) met the inclusion criteria. Mean isotopic LVEF b efore initiation of CAPD was 24.8% +/- 8.2%. All patients were symptom atic from congestive heart failure. Thirteen patients were classified as New York Heart Association grade III or IV. Continuous ambulatory p eritoneal dialysis was associated with a significant improvement of is otopic LVEF, of functional status, and of blood pressure control. In 1 0 patients with a second measurement on CAPD, LVEF increased from a me an value of 23.2% +/- 9.1% to a mean value of 30.3% +/- 8.1% (P < 0.01 ). This represents a 30% increase of LVEF. After 6 months on CAPD, 94% of patients were classified as New York Heart Association grade I or II. Actuarial survival rates were 94%, 80%, and 64% at 12, 18, and 24 months, respectively. The mean duration of CAPD was 24 +/- 17 months. These results suggest that current CAPD treatment is an elective modal ity of treatment in patients with concomitant heart and renal failure. (C) 1995 by the National Kidney Foundation, Inc.