Clinical and hemodynamic results of peritoneal dialysis for severe cardiac failure

Abstract

A total of 16 patients with heart disease of various types underwent peritoneal dialysis for severe and often intractable, cardiac failure. The average amount of fluid removed was 6 liters. Most patients had immediate improvement of symptoms and signs of fluid overload, 12 entered periods of remission, and four were improved enough to undergo corrective surgery, with survival of three. An average weight loss of 6 kilograms occurred during dialysis and 4 kilograms more in the next 2 weeks. Serum sodium and chloride levels were depressed initially and returned toward normal in most patients. The average predialysis sodium and chloride levels were 126 and 86 mEq. per liter, increasing to 136 and 97, respectively. Total blood volume (TBV) was greatly expanded beforehand and decreased with therapy in all 9 patients so studied. The average decrease was from 139 to 109 ml. per kilogram. Cardiac index (CI) was low in all and increased significantly in 6 of 8 patients so studied, the average changing from 1.4 to 1.9 L. per minute per square meter. The decrease in TBV, increase in CI, and sustained clinical improvement were closely associated. There were no definite complications, although in one instance, excessive vascular volume depletion may have contributed to hypotension, oliguria, and death. It is concluded that hypertonic peritoneal dialysis is an effective method for the treatment of severe heart failure with sodium dilution.