Abstract
Peritoneal dialysis is a feasible, cost-effective, home-based treatment of renal replacement therapy, based on the dialytic properties of the peritoneal membrane. As compared with hemodialysis, peritoneal dialysis is cheaper, survival rate is similar, residual kidney function is better preserved, fluid and solutes are removed more gradually and continuously leading to minimal impact on hemodynamics, and risks related to a vascular access are avoided. Those features of peritoneal dialysis are useful to treat refractory congestive heart failure patients with fluid overload. It was shown that in such patients, peritoneal dialysis improves functional status and quality of life, reduces hospitalization rate, and may decrease mortality rate. High levels of serum proinflammatory cytokines and fibrosis markers, among other factors, play an important part in congestive heart failure pathogenesis and progression. We demonstrated that those levels decreased following peritoneal dialysis treatment in refractory congestive heart failure patients. The exact mechanism of beneficial effect of peritoneal dialysis in refractory congestive heart failure is currently unknown. Maintenance of fluid balance, leading to resetting of neurohumoral activation towards a more physiological condition, reduced remodeling due to the decrease in mechanical pressure on the heart, decreased inflammatory cytokine levels and oxidative stress, and a potential impact on uremic toxins could play a role in this regard. In this paper, we describe the unique characteristics of the peritoneal membrane, principals of peritoneal dialysis and its role in heart failure patients.
Highlights
We showed that congestive heart failure (CHF) patients treated with Peritoneal dialysis (PD) had similar survival compared to CHF patients treated with HD, the clinical profiles of those two groups were different [80]
CHF patients treated with PD were younger, had lower blood pressure, more severe heart disease per echocardiography, and higher eGFR compared to those treated with HD
We investigated the effect of peritoneal dialysis treatment on levels of inflammatory cytokines among refractory CHF patients [74] (Figure 2)
Summary
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. Peritoneal dialysis (PD) is a home-based dialysis therapy for patients with end stage kidney disease (ESKD). There are only a few contraindications to peritoneal dialysis These include an inadequate cognitive or physical ability of the patient or an assisting partner to learn and perform peritoneal dialysis and lack of a suitable peritoneal cavity due to extensive scarring or adhesions. In this regard, the degree of scarring could be assessed during the peritoneal cavity laparoscopic visualization at the time of attempted catheter placement and could be treated by adhesiolysis [7]. Health-related quality of life is equivalent for patients who are receiving PD and those receiving HD [12,13]
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