Peritoneal dialysis in the treatment of refractory congestive heart failure stage D

Introduction. Congestive heart failure (CHF) and chronic kidney disease (CKD) are frequent chronic diseases that worsen each other. Ultrafiltration by peritoneal dialysis (PD) has been used to treat CHF stage D associated with CKD stage III-IV, non-responsive to diuretics. Objectives. The aim of the study was to develop PD in this clinical setting in Uruguay and to evaluate its impact on outcome. Material and methods. A prospective, open study was done at the University Hospital, approved by the Ethical Committee. Six patients (5 men) were included with CHF stage D and CKD stage III-IV, non-responsive to maximum drug treatment or intolerance to ACE/ARAII or mineralocorticoid antagonists. The mean age was 68 (61-77) years old, the comorbidity indexes were high (Charlson index, range 6-11) and mean time on PD was 21 +/- 13 months (6-41). Icodextrin was used in 3 patients and automatized PD in 2. Results. In the first semester with PD ultrafiltration, the functional class of NYHA improved, and weight loss, less edema, and lower pulmonary artery systolic pressure with hemodynamic stability were observed. Adequate metabolic control and dialysis doses (Kt/V) was achieved in all cases. Simultaneously, treatment with ACE/ARAII and mineralocorticoid antagonists drugs were re-introduced, without side effects. PD was associated with an improvement in quality of life and lower hospitalization rate. Conclusion. PD in patients with CHF and CKD III-IV achieved ultrafiltration with hemodynamic stability, better NYHA functional class, allowed ACE/ARAII and mineralocorticoid antagonists use, improved quality of life and lowered the hospitalization rate.