Peritoneal Ultrafiltration in Refractory Heart Failure: A Cohort Study

Abstract

♦ Introduction: Acutely decompensated heart failure (HF) in patients with diuretic resistance is often treated with extracorporeal ultrafiltration. Peritoneal ultrafiltration (PUF) has been proposed for the long-term management of severe HF after resolution of the acute episode. The aim of the present study was to evaluate the use of PUF in the treatment of chronic refractory HF in patients without endstage renal disease. ♦ Methods: This multicenter (10 nephrology departments throughout Italy) retrospective observational study included patients with severe HF refractory to maximized drug treatment. The patients were proposed for PUF because they had experienced at least 3 hospital admissions in the preceding year for acutely decompensated HF requiring extracorporeal ultrafiltration. ♦ Results: Of the 48 study patients (39 men, 9 women; mean age 74 ± 9 years), 30 received 1 nocturnal icodextrin exchange, 5 required 2 daily exchanges, and 13 received 2 -4 sessions per week of automated peritoneal dialysis. During the first year, renal function remained stable (initial: 20.8 ± 10.0 mL/min/1.73 m 2 ; end: 22.0 ± 13.6 mL/ min/1.73 m 2 ), while pulmonary artery systolic pressure declined to 40 ± 6.09 mmHg from 45.5 ± 9.18 mmHg (p = 0.03), with a significant concomitant improvement in New York Heart Association functional status. Hospitalizations decreased to 11 ± 17 days/patient-year from 43 ± 33 days/ patient-year before the start of PUF (p < 0.001). The incidence of peritonitis was 1 episode in 45 patient-months. Patient survival was 85% at 1 year and 56% at 2 years. ♦ Conclusions: This study confirms the satisfactory results of using PUF for chronic HF in elderly patients.

Peritoneal Dialysis for Heart Failure

“…Many, if not most, studies have addressed this issue, usually by retrospective comparison to previous admission days, and shown marked reduction in presentations and hospital bed days after institution of therapy (27)(28)(29). A crude figure for the reduction in admissions has been estimated to be ~83% (30) which, if proven in RCTs would almost certainly add substantial economic weight to the proponents of this therapy.…”

Role of Peritoneal Ultrafiltration in Heart Failure Treatment

“…PUF was found to decrease the rate of hospitalization because of acute decomposed HF in several studies (56)(57)(58)(59)(60)(61)(62)(63).…”

“…In many of the other studies that examined the effect of PUF on GFR, PUF was found to be ineffective on GFR (42,56,68,79). In a meta-analysis including six studies with a total of 282 patients without indications of renal replacement therapy, there was no significant difference in GFR before and after PUF (80).…”

“…Because fluid passage through 'icodextrin' is mostly from pores, the so-called 'sodium sieving' phenomenon that can be seen in glucose-based fluids using aquaporin channels is not observed and also the patient is not exposed to glucose toxicity (56,83).…”

Ultrafiltration Treatment in Heart Failure

“…Bertoli ve ark. da böbrek fonksiyonu normal ve diüretik dirençli 48 kalp yetmezliği hastasında benzer faydalar elde etmişlerdir (47). Periton diyalizi ile ultrafiltrasyon günlük 1 değişimden ihtiyaca göre artırılmak suretiyle artırımlı peritoneal ultrafiltrasyon şeklinde uygulanabilir.…”