| Objective The objectives of this study were to compare the clinical effects of hemodialysis and peritoneal dialysis in patients with heart failure complicated with end-stage renal disease(ESRD).The improve of cardiac function,dialysis adequacy,nutritional status,electrolyte disturbance,dialysis complications,cause of death and death rate were analyzed and compared between two groups in order to explore the better renal replacement therapy for ejection fraction reserved heart failure with end-stage renal failure.Methods We have recruited 117 patients from cardiovascular department,renal department and hemodialysis room in our hospital during the period from January 2012 to June 2019.The 117 patients were divided into hemodialysis group(HD)(n=60)and continuous ambulatory peritoneal dialysis group(CAPD)(n=57).This study was to observe and compare the improvement of cardiac function,dialysis adequacy,nutritional status,electrolyte disturbance,dialysis complications,cause of death and?death rate between the two groups.Results There was no significant difference in general conditions before dialysis between the two groups,including age,sex,BMI,mean arterial pressure,heart rate,blood lipids,electrolytes,albumin,liver and kidney function,cardiac function,medical history and medication.In the comparison of cardiac function,there was no significant difference in new york heart association(NYHA)grade and NT-proBNP between the two groups before dialysis.After dialysis,the NYHA grade and rehospitalization rate of heart failure in HD group were significantly lower than those in CAPD group(P<0.05).In terms of dialysis adequacy,the hemodialysis group was significantly better than the continuous ambulatory peritoneal dialysis group.The levels of serum creatinine,urea nitrogen and uric acid in the two groups decreased significantly at the end of observation(P<0.01),but the levels of serum creatinine and urea nitrogen in the hemodialysis group were more significantly lower than those in the peritoneal dialysis group(P<0.01).There was no significant difference in uric acid between the two groups at the end of observation(P<0.05).The serum albumin increased in the hemodialysis group and was significant difference from pre-dialysis at the end of observation(P<0.01),while peritoneal dialysis group was on the contrary(P<0.01).The level of albumin in hemodialysis group was significantly higher than that in CAPD group at the end of observation(P<0.01).The hemoglobin in the two groups was significantly higher than pre-dialysis and the difference was statistically significant(P<0.01).In terms of the effects of electrolytes and blood lipids,serum potassium decreased significantly in peritoneal group before and after dialysis(P<0.01),while serum potassium was relatively stable in hemodialysis group before and after dialysis.There was significant difference in serum potassium between hemodiaysis group and peritoneal group at the end of observation(P<0.01).There was no significant difference in mean arterial pressure and blood lipid in two groups(P<0.05).In terms of heart rate control,the peritoneal dialysis group was better than the hemodialysis group and the difference was statistically significant(P<0.05).Cardiovascular and cerebrovascular diseases,hemorrhagic diseases and severe infection were the main complications of the two groups.In CAPD group,9 cases died,accounting for 15%of the total.In HD group,4 cases died,accounting for 7%of the total.The mortality in HD group was lower than that in CAPD group,and the difference was statistically significant(P=0.02).Cardiac diseases accounted for 46.2%of the total mortality in the two dialysis groups.Among them,there were 4 cases died of severe infection in CAPD group accounting for 44.4%of the deaths.There were 0 cases of severe infection in HD group accounting for 0%of the deaths which was statistically significant(P<0.05).Conclusion Hemodialysis is superior to peritoneal dialysis in the clearance of small molecular metabolites such as creatinine and urea in patients with heart failure and end-stage renal disease.The levels of serum albumin and potassium are higher after hemodialysis while were in decline in CAPD group;There was no significant difference in mean arterial pressure and blood lipids between the two dialysis groups.The heart rate was well controlled in the peritoneal dialysis group;Cardio-cerebrovascular diseases,hemorrhagic diseases and severe infection were the main complications of the two groups.The mortality in HD group(n=4)was lower than that in CAPD group(n=9).Among them,there were 4 cases died of severe infection in CAPD group but 0 cases of severe infection in HD group,The difference was statistically significant.Both hemodialysis and peritoneal dialysis are effective methods for the treatment of ejection fraction retention heart failure with end-stage renal disease,but due to many complications,the selection of appropriate renal replacement therapy and timely replacement of renal replacement therapy may help to improve the survival rate of patients.In this study,we concluded that the effect of hemodialysis on the improvement of cardiac function,dialysis adequacy,nutritional status,electrolyte effect and mortality in patients with ejection fraction reserved heart failure complicated with end-stage renal disease is better than peritoneal dialysis. |
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