Abstract
IntroductionDespite continuous improvement in the treatment, heart failure (HF) is a growing health problem and a major cause of mortality and morbidity in the world. There is some positive experience with the removal of the fluid excess via peritoneum in those patients, regardless of their renal function. The aim of this single center pilot study was to assess the efficacy of peritoneal ultra filtration (PUF) with a nightly 12-h exchange in the long-term treatment of refractory HF.MethodsThe study included patients with chronic HF resistant to updated HF therapy (pharmacological and devices if applicable), who had experienced at least three hospitalizations due to HF during the preceding year and were disqualified from heart transplantation. All of them were treated with nightly 12-h 7.5% icodextrin exchange.ResultsThere were 15 patients (13 men), aged 72 ± 9 years, with charlson comorbidity index (CCI) 9 ± 1.2, NYHA class IV (11 patients) or III (4 patients), and eGFR 32 ± 11 ml/min/1.73m2. They were followed up for 24 ± 8 months (range 12–43, median 26 months). During the 1st year, all patients improved their NYHA functional class from 3.7 ± 0.5 to 2.6 ± 0.5; P = 0.0005, with stable (34.3 ± 12.4, and 35.6 ± 16.5%, respectively) left ventricular ejection fraction (LVEF), and inferior vena cava (IVC) diameter decreased from 27.8 ± 2.7 to 24.4 ± 3.4 mm; P = 0.09. Daily diuresis increased from 867 ± 413 to 1221 ± 680 ml; P = 0.25, while the dose of furosemide could be reduced from 620 ± 256 to 360 ± 110 mg/d; P = 0.0005, however, the kidney function deteriorated, with eGFR drop from 32 ± 11 to 25.6 ± 13 ml/min/1.73m2; P = 0.01). HF-related hospitalizations decreased from 8.9 ± 2.8 days/month to 1.5 ± 1.2 days/month (P = 0.003). Mechanical peritoneal dialysis complications occurred in five patients and infectious complications in four (peritonitis rate 1 per 72 patient-month). Patient survival was 93% at 1 year and 73% at 2 year. Technique survival was 100%.ConclusionIn patients with refractory HF, PUF with one overnight icodextrin exchange appears to be a promising therapeutic option as an adjunct to pharmacological management of those who are not transplant candidates. It should be emphasized that the treatment can have a great impact on the quality of life and the total costs of treating these patients.
Highlights
Despite continuous improvement in the treatment, heart failure (HF) is a growing health problem and a major cause of mortality and morbidity in the world
The treatment with only one overnight icodextrin exchange was continued for 13 ± 6 months
The leading reason of the changes in peritoneal ultra filtration (PUF) prescription such as increasing the number of manual exchanges or switching the patient to automated peritoneal dialysis (PD) was the need for more intensive fluid and/or solutes removal
Summary
Despite continuous improvement in the treatment, heart failure (HF) is a growing health problem and a major cause of mortality and morbidity in the world. For the selected patients a device therapy, surgery and transplantation may be offered, many of them are not suitable for these invasive procedures, mainly due to age and coexisting diseases Survival of such patients is less than 50% at 6 months, and the treatment with many hospitalizations constitutes a remarkable financial burden and confers suffering and a poor quality of life (Dickstein et al, 2008; Damman et al, 2009; Jessup et al, 2009). The coexistence of cardiac and renal dysfunction induces a vicious circle that leads to an aggravation of both pathologies, chronic cardiorenal syndrome (CRS) development, and refractoriness to the treatment with decreased delivery of diuretics to their effector sites in the nephron (Ronco et al, 2008; Damman et al, 2009; Mullens et al, 2009) This spiral results in a further water and salt retention, further decline in cardiac output, and hypotension, with pulmonary edema and death (Ronco et al, 2008; Mullens et al, 2009). This huge reduction in hospital admissions, despite the cost of PUF, may have a marked financial aspect, as shown by Sánchez et al (2010)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
