Reply

Raymond Azar, Laurence Hogede and Valerie Carru

Dunkerque General Hospital, Nephrology Department, Dunkerque, France Email: raymondazar{at}netinfo.fr

Sir,

We read with interest the letter of Hausmann and Liel-Cohen [1] related to the usefulness of Aldactone therapy in a peritoneal dialysis patient with decreased systolic left ventricular function and diastolic dysfunction. Taking a larger experience into account, we agree with their conclusions about the safety and the usefulness of this therapy in such patients. We treated 15 patients with refractory congestive heart failure and a certain degree of renal failure by a combination of CAPD and drug therapy using ACE inhibitors, beta-blockers, furosemide and spironolactone. We observed a significant improvement of the clinical conditions and of their functional capacities in all patients. The best results were noted in patients with no or moderate malnutrition. We did not observe any hyperkalaemia (>5.5 mEq/l) over a mean period of 24±6 months of treatment. Aldactone was used at a mean dose of 25 mg daily. Owing to the continuous character of peritoneal dialysis, hyperkalaemia may be a minor concern in dialysis patients treated by Aldactone but may be more problematic in discontinuous dialysis such as haemodialysis and in patients with various degrees of renal failure alone or in combination with ACE inhibitors or ARA II [2,3].

In our opinion, anti-aldosterone therapy is feasible in patients with refractory heart failure treated by CAPD with a tolerable level of security, considering the risk of hyperkalaemia, and may lead to a significant improvement of quality of life and perhaps of the survival in this group of patients [4].

Conflict of interest statement. None declared.

References

  1. Hausmann MJ, Liel-Cohen N. Aldactone therapy in a peritoneal dialysis patient with decreased left ventricular function. Nephrol Dial Transplant 2002; 17:2035[Free Full Text]
  2. Ryckelynck J Ph, Lobbedez Th, Valette B et al. Peritoneal ultrafiltration and treatment-resistant heart failure. Nephrol Dial Transplant 1998; 13 [Suppl 4]:56–59[Free Full Text]
  3. Elhalel-Dranitziki M, Rubinger D, Moscovici A et al. CAPD to improve quality of life in patients with refractory heart failure. Nephrol Dial Transplant 1998; 13:3041–3042[Abstract]
  4. Mehrotra R, Khanna R. Peritoneal ultrafiltration for chronic congestive heart failure: rationale, evidence and future. Cardiology 2001; 96:177–182[CrossRef][ISI][Medline]




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