Characteristics and mortality of patients with and without cardio-renal syndrome treated by peritoneal dialysis in France




peritoneal dialysis, cardio-renal syndrome, outcome, mortality, peritonitis



Overall, peritoneal dialysis (PD) is increasingly indicated for refractory heart failure. The aim of this study was to analyze the characteristics and survival of PD patients with and without cardiorenal syndrome (CRS) in France.

This was a retrospective study that included all patients enrolled in the French Language Peritoneal Dialysis Registry (RDPLF) between 01/01/2010 and 01/12/2021. The cohort was divided into two groups to compare patients with and without CRS. Survival was analyzed by the Kaplan-Meier method, and the log-rank test was used to compare the two groups. Factors associated with mortality in both groups were identified with Cox regression analysis.

11,730 PD patients were included. Their mean age was 66.78±16.72 years. Of these patients, 766 (6.53%) were managed in PD for CRS and 10,964 for another initial kidney disease. Patients with CRS were older and had more comorbidities. Survival was significantly better in the group without CRS. The median survival times were 17.7±1.2 months and 49.6±0.7 months in patients with and without CRS, respectively. Multivariate Cox regression analysis revealed that age, male sex, diabetes, cardiovascular pathology, and lack of autonomy were factors associated with increased mortality in the group without CRS. In patients with CRS, only the variables age and history of liver disease were significantly associated with an increased risk of death. The number of peritonitis episodes with which a patient presented was significantly associated with a lower risk of death in both groups.

This nationwide study of a large number of patients treated with PD revealed the large differences in characteristics and survival between those with and without CRS. In particular, the two factors most related to mortality in the group with CRS were age and liver disease.


Ronco C, McCullough P, Anker SD, Anand I, Aspromonte N, Bagshaw SM, Bellomo

R, Berl T, Bobek I, Cruz DN, Daliento L, Davenport A, Haapio M, Hillege H, House

AA, Katz N, Maisel A, Mankad S, Zanco P, Mebazaa A, Palazzuoli A, Ronco F, Shaw

A, Sheinfeld G, Soni S, Vescovo G, Zamperetti N, Ponikowski P; Acute Dialysis

Quality Initiative (ADQI) consensus group. Cardio-renal syndromes: report from

the consensus conference of the acute dialysis quality initiative. Eur Heart J.

Mar;31(6):703-11. doi: 10.1093/eurheartj/ehp507. Epub 2009 Dec 25. PMID:

; PMCID: PMC2838681.

Ter Maaten JM, Damman K, Verhaar MC, Paulus WJ, Duncker DJ, Cheng C, van

Heerebeek L, Hillege HL, Lam CS, Navis G, Voors AA. Connecting heart failure

with preserved ejection fraction and renal dysfunction: the role of endothelial

dysfunction and inflammation. Eur J Heart Fail. 2016 Jun;18(6):588-98. doi:

1002/ejhf.497. Epub 2016 Feb 10. PMID: 26861140.

Damman K, Valente MA, Voors AA, O'Connor CM, van Veldhuisen DJ, Hillege HL.

Renal impairment, worsening renal function, and outcome in patients with heart

failure: an updated meta-analysis. Eur Heart J. 2014 Feb;35(7):455-69. doi:

1093/eurheartj/eht386. Epub 2013 Oct 27. PMID: 24164864.

Heiat A, Gross CP, Krumholz HM. Representation of the elderly, women, and

minorities in heart failure clinical trials. Arch Intern Med. 2002 Aug

-26;162(15):1682-8. doi: 10.1001/archinte.162.15.1682. PMID: 12153370.

Xanthakis V, Enserro DM, Larson MG, Wollert KC, Januzzi JL, Levy D, Aragam J,

Benjamin EJ, Cheng S, Wang TJ, Mitchell GF, Vasan RS. Prevalence, Neurohormonal

Correlates, and Prognosis of Heart Failure Stages in the Community. JACC Heart

Fail. 2016 Oct;4(10):808-815. doi: 10.1016/j.jchf.2016.05.001. Epub 2016 Jul 6.

PMID: 27395350; PMCID: PMC8450920.

Yeates K, Zhu N, Vonesh E, Trpeski L, Blake P, Fenton S. Hemodialysis and

peritoneal dialysis are associated with similar outcomes for end-stage renal

disease treatment in Canada. Nephrol Dial Transplant. 2012 Sep;27(9):3568-75.

doi: 10.1093/ndt/gfr674. Epub 2012 Mar 5. PMID: 22391139.

Indications et non indications de la dialyse péritonéale chez l’adulte. Recommandations HAS 2007.

Moist LM, Port FK, Orzol SM, Young EW, Ostbye T, Wolfe RA, Hulbert-Shearon T,

Jones CA, Bloembergen WE. Predictors of loss of residual renal function among

new dialysis patients. J Am Soc Nephrol. 2000 Mar;11(3):556-564. doi:

1681/ASN.V113556. PMID: 10703680.

Bertoli SV, Musetti C, Ciurlino D, Basile C, Galli E, Gambaro G, Iadarola G,

Guastoni C, Carlini A, Fasciolo F, Borzumati M, Gallieni M, Stefania F.

Peritoneal ultrafiltration in refractory heart failure: a cohort study. Perit

Dial Int. 2014 Jan-Feb;34(1):64-70. doi: 10.3747/pdi.2012.00290. Epub 2013 Oct

PMID: 24179103; PMCID: PMC3923694.

Grossekettler L, Schmack B, Meyer K, Brockmann C, Wanninger R, Kreusser MM,

Frankenstein L, Kihm LP, Zeier M, Katus HA, Remppis A, Schwenger V. Peritoneal

dialysis as therapeutic option in heart failure patients. ESC Heart Fail. 2019

Apr;6(2):271-279. doi: 10.1002/ehf2.12411. Epub 2019 Feb 27. PMID: 30815994;

PMCID: PMC6437425.

Sánchez JE, Ortega T, Rodríguez C, Díaz-Molina B, Martín M, Garcia-Cueto C,

Vidau P, Gago E, Ortega F. Efficacy of peritoneal ultrafiltration in the

treatment of refractory congestive heart failure. Nephrol Dial Transplant. 2010

Feb;25(2):605-10. doi: 10.1093/ndt/gfp484. Epub 2009 Sep 25. PMID: 19783594.

Courivaud C, Kazory A, Crépin T, Azar R, Bresson-Vautrin C, Chalopin JM,

Ducloux D. Peritoneal dialysis reduces the number of hospitalization days in

heart failure patients refractory to diuretics. Perit Dial Int. 2014 Jan-

Feb;34(1):100-8. doi: 10.3747/pdi.2012.00149. Epub 2013 Sep 1. PMID: 23994842;

PMCID: PMC3923699.

Khalifeh N, Vychytil A, Hörl WH. The role of peritoneal dialysis in the

management of treatment-resistant congestive heart failure: A European

perspective. Kidney Int Suppl. 2006 Nov;(103):S72-5. doi: 10.1038/

PMID: 17080115.

Puttagunta H, Holt SG. Peritoneal Dialysis for Heart Failure. Perit Dial Int.

Nov;35(6):645-9. doi: 10.3747/pdi.2014.00340. PMID: 26702006; PMCID:


Lu R, Muciño-Bermejo MJ, Ribeiro LC, Tonini E, Estremadoyro C, Samoni S,

Sharma A, Zaragoza Galván Jde J, Crepaldi C, Brendolan A, Ni Z, Rosner MH, Ronco

C. Peritoneal dialysis in patients with refractory congestive heart failure: a

systematic review. Cardiorenal Med. 2015 Apr;5(2):145-56. doi:

1159/000380915. PMID: 25999963; PMCID: PMC4427136.

Núñez J, González M, Miñana G, Garcia-Ramón R, Sanchis J, Bodí V, Núñez E,

Puchades MJ, Palau P, Merlos P, Llàcer A, Miguel A. Continuous ambulatory

peritoneal dialysis as a therapeutic alternative in patients with advanced

congestive heart failure. Eur J Heart Fail. 2012 May;14(5):540-8. doi:

1093/eurjhf/hfs013. Epub 2012 Feb 9. PMID: 22327061.

Koch M, Haastert B, Kohnle M, Rump LC, Kelm M, Trapp R, Aker S. Peritoneal

dialysis relieves clinical symptoms and is well tolerated in patients with

refractory heart failure and chronic kidney disease. Eur J Heart Fail. 2012

May;14(5):530-9. doi: 10.1093/eurjhf/hfs035. Epub 2012 Mar 23. PMID: 22447950.

Ryckelynck JP, Lobbedez T, Valette B, Le Goff C, Mazouz O, Levaltier B,

Potier JC, Hurault de Ligny B. Peritoneal ultrafiltration and treatment-

resistant heart failure. Nephrol Dial Transplant. 1998;13 Suppl 4:56-9. doi:

1093/ndt/13.suppl_4.56. PMID: 9614668.

Jois P, Mebazaa A. Cardio-renal syndrome type 2: epidemiology,

pathophysiology, and treatment. Semin Nephrol. 2012 Jan;32(1):26-30. doi:

1016/j.semnephrol.2011.11.004. PMID: 22365159.

Uduman J. Epidemiology of Cardiorenal Syndrome. Adv Chronic Kidney Dis. 2018

Sep;25(5):391-399. doi: 10.1053/j.ackd.2018.08.009. PMID: 30309456.

Aubry A, Paternot A, Vieillard-Baron A. Cœur pulmonaire [Cor pulmonale]. Rev

Mal Respir. 2020 Mar;37(3):257-266. French. doi: 10.1016/j.rmr.2019.10.012. Epub

Feb 19. PMID: 32088063.

El Hadi H, Di Vincenzo A, Vettor R, Rossato M. Relationship between Heart

Disease and Liver Disease: A Two-Way Street. Cells. 2020 Feb 28;9(3):567. doi:

3390/cells9030567. PMID: 32121065; PMCID: PMC7140474.

Zhang J, Lu X, Li H, Wang S. Risk factors for mortality in patients undergoing peritoneal dialysis: a systematic review and meta-analysis. Ren Fail. 2021 Dec;43(1):743-753. doi: 10.1080/0886022X.2021.1918558. PMID: 33913381;

rapport REIN 2019

Sato Y, Yoshihisa A, Kanno Y, Watanabe S, Yokokawa T, Abe S, Misaka T, Sato T, Suzuki S, Oikawa M, Kobayashi A, Yamaki T, Kunii H, Nakazato K, Saitoh SI, Takeishi Y. Liver stiffness assessed by Fibrosis-4 index predicts mortality in patients with heart failure. Open Heart. 2017 Apr 28;4(1):e000598. doi: 10.1136/openhrt-2017-000598. PMID: 28674631

Pérez Fontan M, Rodríguez-Carmona A, García-Naveiro R, Rosales M, Villaverde

P, Valdés F. Peritonitis-related mortality in patients undergoing chronic

peritoneal dialysis. Perit Dial Int. 2005 May-Jun;25(3):274-84. PMID: 15981776.

Hsieh YP, Chang CC, Wen YK, Chiu PF, Yang Y. Predictors of peritonitis and

the impact of peritonitis on clinical outcomes of continuous ambulatory

peritoneal dialysis patients in Taiwan--10 years' experience in a single center.

Perit Dial Int. 2014 Jan-Feb;34(1):85-94. doi: 10.3747/pdi.2012.00075. Epub 2013

Oct 1. PMID: 24084840;

Gadola L, Poggi C, Dominguez P, Poggio MV, Lungo E, Cardozo C. Risk Factors

And Prevention of Peritoneal Dialysis-Related Peritonitis. Perit Dial Int. 2019

Mar-Apr;39(2):119-125. doi: 10.3747/pdi.2017.00287. Epub 2018 Sep 25. PMID:

Ye H, Zhou Q, Fan L, Guo Q, Mao H, Huang F, Yu X, Yang X. The impact of

peritoneal dialysis-related peritonitis on mortality in peritoneal dialysis

patients. BMC Nephrol. 2017 Jun 5;18(1):186. doi: 10.1186/s12882-017-0588-4.

PMID: 28583107.



How to Cite

Duneau G, Aoun M. Characteristics and mortality of patients with and without cardio-renal syndrome treated by peritoneal dialysis in France. Bull Dial Domic [Internet]. 2022 Dec. 28 [cited 2024 Feb. 28];5(4):43-9. Available from: