Peritoneal ultrafiltration in congestive heart failure-findings reported from its application in clinical practice: a systematic review

Introduction Peritoneal ultrafiltration (PUF) is proposed in the long-term treatment of congestive heart insufficiency. However, the data in literature available at present do not allow for conclusive meta-analysis. Objective/materials and methods A systematic review of the literature (MEDLINE-EMBASE, 01/01/2003-31/12/2013, studies with >= 4 patients, adults, non-ESRD) to highlight which patients PUF has been used in, how and with what results. Results Consideration was given to 14 papers for a total of 471 patients. (1) Characteristics of the patients. Average age 71.6 years; diabetes mellitus (DM) 47 %; New York Heart Association (NYHA) class III 38.9 %-class IV 59.8 %; ischemic cardiopathy 67.8 %; mean LVEF 35 %. (2) PUF modality. Only continuous ambulatory peritoneal dialysis (CAPD) in ten studies, only APD in two studies, both in two studies. Overall CAPD was used in 56.2 % of the pts. A single exchange of icodextrin was used to treat 51 % of patients on CAPD. The volume of ultrafiltration obtained varied between 390 and 1,180 ml/die. (3) Effects of PUF. Significant improvement in NYHA class and reduction in hospitalizations. Survival at 12 months varying between 47 and 95 %. Mortality seems to be associated with DM, higher basal glomerular filtration rate, less change in ejection fraction after PUF and less use of ICOs. Limitation The main limitation of the selected studies, mostly retrospective and with a limited number of patients, remains the lack of clarity and uniformity of the selection criteria used. For this reason extrapolations about survival require extreme caution and are not currently possible. Conclusions PUF improves symptomatology and reduces hospitalizations.