Abstract
Congestive heart failure unresponsive to maximal drug treatment has been known to benefit from UF. We wish to report our experience with peritoneal UF using Extraneal®. Eight patients with severe CHF (NYHA stages III in 3 and IV in 5 with ejection fractions under 30% in all), and one with diabetic nephrotic syndrome, unresponsive to dietary and drug treatments (ACE-I, diuretics, digitalis, vasodilators) were offered to try Extraneal® therapy after informed consent. Three of them had normal renal function while six had various degrees of renal impairment (creatinine clearances ranging from 25 to 60 ml/min.). The causes of CHF were diabetic and ischemic cardiomyopathies in 1 and 7 patients, respectively. Depending on the level of renal function (< or ± 50 ml/mm) and on the degree of overhydration, one or two 2 L exchanges were applied with dwells of 24 or 12 hrs, respectively. Resulting daily ultrafiltration varied from 750 to 1400 ml, achieving a weight loss of 4 to 6.3 kg during the first week. Thereafter, UF was adapted to the desired weight loss (maximum: 20 kg over 1 month). No significant hypotension occurred despite a basal BP no higher than 115/60 mm Hg. Four patients progressed to more severe renal failure needing 3 or more glucose exchanges, 3 patients did regain enough compensation to stop UF, and one received a successfull heart transplantation after 29 months. There were 4 episodes of peritonitis over 100 patients-months. Hospitalisation rate was reduced from 1.5/month in the 6 months before UF to 0.2/month over the mean 12 months of follow-up. There were no side effects of Extraneal®. In conclusion, UF with Extraneal® is practical (1 or 2 manipulations per day), efficient and well-tolerated. It can improve possibly survival and certainly quality of life in patients with severe CHF or nephrotic syndrome.
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