Is haemodialysis useful in severe right heart failure?

Abstract

Congestive heart failure is the most common cause of mortality in patients with end-stage renal disease [1,2]. Chronic hypervolemia and uremia may negatively affect the myocardium of both ventricles [1]. Preload reduction by haemodialysis improves myocardial interstitial edema and left ventricular diastolic function in patients with end-stage renal disease and congestive heart failure [2]. Although haemodialysis has been proved effective in congestive heart failure due to end-stage renal disease, little is known about its possible role in isolated end-stage right heart failure without severe renal disease, unresponsive to conservative and pharmacological therapies. A 51-year-old male with severe, end-stage, right heart failure on the ground of alcoholic myocardiopathy, successfully treated by haemodialysis, is reported. The patient admitted with tense ascitis, hepatomegaly and severe lower limp and scrotal oedema. He reported a 5-year history of alcoholic cardiomyopathy treated by furocemide, spironolactone and digitalis. All other personal and family history was negative. Clinical examination upon admission showed: tension: 110/70 mm Hg, heart rate 75/min, weight: 108 kg, while ECG showed LBBB. Laboratory examination showed: urea 93 mg/dl (normal<48), creatinin 1.7 mg/dl (normal<1.3), bilirubin (total/direct) 2.1/0.51 mg/dl, while all other hematological and blood chemistry results were normal. Thorax photo revealed cardiomegaly. Thorax and abdominal computed tomography (CT) showed significant amount of ascitic fluid without pericardiac collection. During his hospitalization the patient was managed with intensive diuresis (furocemide up to 400 mg intravenously