0391-3988/492-04$25.00/0 © Wichtig Editore, 2009 The International Journal of Artificial Organs / Vol. 32 / no. 8, 2009 / pp. 492-495 Artificial Kidney and Dialysis INTRODUCTION Since the mean age of the dialysis population is increas- ing, cardiovascular disease has become a major cause of morbidity and mortality in uremic patients with arterial damage; furthermore, a growing number of patients with advanced vascular damage need renal replacement ther- apy (RRT) (1). The prevalence of heart failure in the elderly population is persistently increasing due to the extensive application of interventional procedures; chronic kidney disease negatively impacts cardiovascular outcomes and mortality in elderly subjects (2). The progressive ageing of the population will increase the number of patients with combined heart and kidney failure as well as their need for care, with a consequent rise in costs. We analyzed patients with RCHF who started dialysis between 2005 and 2006 and conducted an observational cohort study in order to evaluate the clinical features of these patients beginning RRT and their survival. PATIENTS AND METHODS We performed an observational cohort study of 33 con- secutive uremic patients with a diagnosis of RCHF who started RRT between 2005 and 2006. Eligibility criteria for the study were a history of CHF and chronic renal failure in patients who had been treated at the heart failure clinic of our hospital for at least six months and who were referred to the dialysis unit for worsening renal function and/or dys- Dialysis initiation and survival in patients with refractory congestive heart failure FABIO FABBIAN, STEFANO CANTELLI, CHRISTIAN MOLINO, MARCO PALA, CARLO LONGHINI Department of Clinical and Experimental Medicine, St. Anna University-Hospital, Ferrara - Italy ABSTRACT: Background: It has been reported that more than 30% of patients present with conges- tive heart failure at the initiation of renal replacement therapy (RRT). We followed up a cohort of pa- tients with refractory congestive heart failure (RCHF) who started dialysis between 2005 and 2006 and conducted an observational cohort study in order to evaluate the clinical features at the time RRT was started, and the survival rate of patients with RCHF. Methods: Data were collected on 33 uremic subjects (24 male) with RCHF, referred by cardiologists, who started dialysis between 2005 and 2006 and were followed-up for 42 months. The following pa- rameters were derived from clinical records: age, sex, history of ischemic heart disease (IHD), cerebro- vascular disease (CVD), peripheral vascular disease (PVD), diabetes, smoking, hypertension, myeloma or malignancies, the cause for dialysis and procedure used to initiate treatment. Results: RCHF was the cause of initial RRT in 15 patients in 2005 and in 18 the following year, with an incidence of 27 out of 100 patients per year. Diabetes was diagnosed in 51% (n=17) of cases. More than 80% of patients with RCHF had histories of hypertension and smoking. IHD, CVD and PVD were present in 66%, 30% and 54% of cases, respectively. Cancers were recorded in 36% of subjects. Fluid overload was the cause of urgent dialysis in 73% of cases; a central venous catheter (CVC) was placed in 75% of patients. Mean survival of patients with RCHF was 23 months. Eighteen patients died because of cardiovascular events after a mean follow-up of 365±387 days; they had higher prevalence of a smoking history (100% vs. 73%, p=0.02) and CVD (44% vs. 13%, p=0.05) than the survivors. Conclusions: In uremic patients starting dialysis, RCHF appears to be a frequent condition, comorbidity is high and they require urgent treatment by CVC because of fluid overload. Since RCHF is time- and re- source-consuming, nephrologists need to ameliorate its management. (Int J Artif Organs 2009; 32: 492-5) KEY WORDS: Refractory congestive heart failure (RCHF), Dialysis, Uremia, Survival