Palabras clave
síndrome cardiorrenal
diálisis
diálisis peritoneal
soluciones para diálisis
Cómo citar
Resumen
Contexto: la insuficiencia cardiaca congestiva refractaria (ICCR) constituye no solo una causa de mortalidad en el paciente con enfermedad cardiovascular, sino que la sintomatología congestiva genera morbilidad, deterioro de la calidad de vida, múltiples hospitalizaciones y aumento de los costos en salud. Las terapias farmacológicas convencionales para manejar la congestión pueden ser retadoras o contraindicadas en pacientes con ICCR y enfermedad renal crónica (ERC), especialmente en condiciones agudas o con síndrome cardiorrenal. La diálisis peritoneal, con sus diversas modalidades, ofrece beneficios significativos para los pacientes con congestión refractaria; no obstante, muchos equipos multidisciplinarios desconocen aspectos específicos de las soluciones y prescripciones de diálisis peritoneal.
Objetivo: proporcionar una síntesis narrativa y recomendaciones multidisciplinarias sobre la diálisis peritoneal en pacientes con ICCR.
Metodología: se realizó una revisión no sistemática de la literatura junto con una perspectiva multidisciplinaria para presentar una síntesis de las recomendaciones actuales para la prescripción de diálisis peritoneal personalizada en falla cardiaca congestiva, con un enfoque centrado en el paciente y su familia.
Resultados: la evidencia extraída muestra la diálisis peritoneal como alternativa terapéutica para paciente con insuficiencia cardiaca congestiva refractaria (ICCR) permitiendo el manejo del volumen, el mantenimiento de la tasa de filtración glomerular con respecto a otras terapias, además de reducir la carga ventricular y la congestión, y mejorar clase funcional. Existe variabilidad en las prácticas de prescripción por lo que se hace una propuesta de prescripción de DP con base fisiológica. A través de las necesidades actuales de la enfermedad se propone un manejo personalizado con un modelo multidisciplinario para el manejo del paciente con ICCR, desde un enfoque centrado en el paciente y la familia.
Conclusiones: la DP es una opción terapéutica viable y costo-efectiva en casos de ICCR con opciones limitadas. Su éxito depende de un enfoque multidisciplinario, de la buena comunicación y del seguimiento clínico, por lo que conocer la fisiología de la DP y ajustar la terapia de forma individualizada mejora los resultados.
Citas
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