Use of peritoneal ultrafiltration in the elderly refractory congestive heart failure patients

Abstract

Peritoneal ultrafiltration seems to be an efficient and safe procedure and a treatment of choice in elderly patients with RCHF without non-terminal CKD. Peritoneal ultrafiltration improves the quality of life and the effort capacity, and reduces hospitalization rates due to decompensated heart failure and acute renal failure.

Role of Peritoneal Ultrafiltration in Heart Failure Treatment

“…Patient's preference as well as the clinical situation determines primarily the choice of UF for night or day and instrumental or manual methods. It has been shown that the rate of infection was lower with the use of single change instead of multiple changes (42,47,68,82). Especially in patients with residual renal function, the use of 'icodextrin', which provides long-term UF and allows single change, appears to be a more practical and appropriate option.…”

Peritoneal ultrafiltration in end-stage congestive heart failure

“…Unfortunately, they are uncontrolled and the groups studied are small. Patients with coexisting renal failure may be treated with intermittent PD [21], continuous ambulatory PD [22][23][24][25][26] or automated PD [27][28][29][30], while in those without significant impairment of renal function -a single nightly exchange (PUF) with osmotic agent (optimally icodextrin) is sufficient [31][32][33][34][35]. In the vast majority of cases PD/PUF was performed in patients with advanced CHF and symptoms of cardiorenal syndrome as an addition to standard therapy.…”

“…It usually concerned elderly patients with numerous comorbidities and various degrees of renal impairment, disqualified from heart transplantation and refractory to pharmacological treatment. In some centers, extracorporeal UF was initially performed for quick reduction of fluid overload [28,29,[32][33][34][35], while in the others therapy was commenced with PUF or PD. PUF/PD dose was matched to individual patient's needs in order to obtain optimal UF on one hand, while achieving adequate balancing of metabolic disturbances associated with renal impairment on the other.…”

“…The most important clinical studies on PD or an isolated PUF are presented in pt -patient; NA -data not available; PD -peritoneal dialysis Ewa Wojtaszek et al, Peritoneal ultrafiltration in end-stage congestive heart failure to diuretics, allowing for a significant (by as much as 50%) dose reduction and increased diuresis with stable renal function during the observation period [26,29,[32][33][34][35]. The effect of continuous, slow removal of water and sodium excess via peritoneal cavity may be of significance here, as it facilitates gradual reduction of extracellular volume and, subsequently, maintenance of normovolemia and neurohormonal stabilization.…”

Ultrafiltration Therapy for Cardiorenal Syndrome: Physiologic Basis and Contemporary Options

“…One approach was initial in-hospital hemofiltration for decompensated HF, followed by outpatient PD with incrementally increasing intensity [42]. Despite these limitations and potential bias, most studies do report an improvement in HF functional class or measures of quality of life [42,43,44,45,46,47], and reduction in the number of hospitalizations or days admitted [42,43,44,45,48]. Other objective findings included reduction in body weight [43,46], better echocardiographic or other measured cardiac hemodynamic parameters [42,43,44], and improved HF biomarkers (i.e.…”