Herz und Nieren - nur gemeinsam sind sie stark - Fall 5/2011

HISTORY AND ADMISSION FINDINGS: We report on two patients with cardiorenal and renocardiac syndrome, respectively, who were treated with peritoneal dialysis. INVESTIGATIONS: Patient 1 suffered from dilated cardiomyopathy with an ejection fraction of 20%. There was no hint for an intrinsic renal disease, urinalysis showed microalbuminuria at the most. Due to progressive cardiac forward failure kidney dysfunction and diuretic-refractory volume retention developed. Patient 2 was admitted with an uremic syndrome and newly developed atrial fibrillation. Echocardiography revealed a hitherto unknown dilated cardiomyopathy. DIAGNOSIS, TREATMENT AND COURSE: Both patients were treated with continuous ambulatory peritoneal dialysis. This led to regression of the uremic complications. Sinus rhythm was restored in patient 2 after two weeks and cardiomyopathy was reversed after another 9 months. CONCLUSIONS: End-stage heart failure results in kidney dysfunction which can progress to a dialysis-dependent state. End-stage renal failure is often accompanied by cardiac dysfunction and failure.