PERITONEAL ULTRAFILTRATION(UF)WITH EXTRANEAL® FOR OVERHYDRATION DUE TO CONGESTIVE HEART FAILURE (CHF) AND NEPHROTIC SYNDROME

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.