Peritoneal dialysis in refractory end-stage congestive heart failure: a challenge facing a no-win situation

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Abstract
Background. Current medical therapeutic strategies for refractory congestive heart failure (CHF) in the population of 65 years and older with contraindications for heart transplantation are limited. Peritoneal dialysis applied to CHF patients with or without renal impairment showed clinical functional improvement. Methods. A single centre, prospective but non-randomized study in 20 patients with severe congestive heart failure refractory to optimal pharmacological therapy [New York Heart Association (NYHA), class IV] was performed between 2000 and 2003. The mean age was 65.71±7.66 years. The patients had a baseline glomerular filtration rate of 14.84±3.8 ml/min. Fifteen patients were diabetics (type I, 10; type II, five). For all patients, the baseline ejection fraction was Results. After 1 year of follow-up, all patients showed haemodynamic improvement: significant improvement of left cardiac work index (2.33±0.69 to 2.59±0.47 kg min/m2), reduction of the systolic times ratio (61.14±12.57 to 39.18±13.44%), lower thoracic fluid contents (0.04±0.005 to 0.003±0.0001 Ω) as well as a regression from NYHA class IV to class I. Need for hospitalization for CHF decreased from 157 to 13 days. Conclusions. Peritoneal dialysis appears to be a promising therapeutic tool for patients affected by refractory CHF. Clinical improvement of cardiac function may be related to clearing blood from middle molecular weight myocardial depressant substances, including atrial natriuretic peptide. Prospective multicentre trials are needed to confirm these encouraging results.

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