0122: Peritoneal dialysis and heart failure: designing of the heart module in the French speaking peritoneal dialysis registry (RDPLF)

Heart failure (HF) is a frequent and severe comorbidity in dialysis patients (pts); conversely, 30% of pts in the large Acute Decompensated Heart Failure National Registry had moderate to severe chronic kidney disease and 5% were receiving dialysis therapy. Refractory HF is a not uncommon indication for peritoneal ultrafiltration although its benefits have been unconsistently reported through mainly retrospective or monocentric studies. The main objectives of the “heart module” are to prospectively collect data related to cardiac status in PD pts and to allow longitudinal follow-up of cardiac- and dialysisrelated parameters in HF ptsMethodsThe RDPLF constitutes the largest recruiting observational cohort of French speaking PD pts, with coverage estimated at 98,3% of PD in France in 2013. All centers complete a set of core modules covering sociodemographics and basic clinical information, peritonitis episodes, and outcomes. Optional specialized modules are available. The heart module consists of baseline followed by quarterly collection of information related to cardiac disease, hospitalization rate, and dialysis-related parameters.Results14 centers volunteered to participate since the heart module was launched in February 2013, now totalizing 75 pts. PD was initiated because of HF in 73%. Mean eGFR was 22±14ml/mn/1.73m2 with GFR>15ml/mn/ 1.73m2 in 69%. Half of the pts had echocardiographic Left Ventricular Ejection Fraction (LVEF)<30% and 71% pts had NYHA III-IV status. Mean rate of hospitalization the previous year was 30.8 days/pts/yr. Follow-up data were obtained in 38 pts at 3 months. Hospitalization rate decreased from 8.4 days/ 100 days to 4.7 days/100 days. LVEF increased by more than 10% in 13/ 23 pts. Mortality rate was 15.6% among the 32 pts with 1-year follow-up.ConclusionsExpanding this cohort will give the unique opportunity to define features of HF requiring PD and clarify which pts take most benefit from the strategy. The rapid decrease of hospitalization rate is confirmatory of previous studies

A randomized multicenter trial on a lung ultrasound-guided treatment strategy in patients on chronic hemodialysis with high cardiovascular risk see commentary

Lung congestion is a risk factor for all-cause and cardiovascular mortality in patients on chronic hemodialysis, and its estimation by ultrasound may be useful to guide ultrafiltration and drug therapy in this population. In an international, multi-center randomized controlled trial (NCT02310061) we investigated whether a lung ultrasound-guided treatment strategy improved a composite end point (all-cause death, non-fatal myocardial infarction, decompensated heart failure) vs usual care in patients receiving chronic hemodialysis with high cardiovascular risk. Patient-Reported Outcomes (Depression and the Standard Form 36 Quality of Life Questionnaire, SF36) were assessed as secondary outcomes. A total of 367 patients were enrolled: 183 in the active arm and 180 in the control arm. In the active arm, the pre-dialysis lung scan was used to titrate ultrafiltration during dialysis and drug treatment. Three hundred and seven patients completed the study: 152 in the active arm and 155 in the control arm. During a mean follow-up of 1.49 years, lung congestion was significantly more frequently relieved in the active (78%) than in the control (56%) arm and the intervention was safe. The primary composite end point did not significantly differ between the two study arms (Hazard Ratio 0.88; 95% Confidence Interval: 0.63-1.24). The risk for all-cause and cardiovascular hospitalization and the changes of left ventricular mass and function did not differ among the two groups. A post hoc analysis for recurrent episodes of decompensated heart failure (0.37; 0.15-0.93) and cardiovascular events (0.63; 0.41-0.97) showed a risk reduction for these outcomes in the active arm. There were no differences in patientreported outcomes between groups. Thus, in patients on chronic hemodialysis with high cardiovascular risk, a treatment strategy guided by lung ultrasound effectively relieved lung congestion but was not more effective than usual care in improving the primary or secondary end points of the trial.Clinical epidemiolog