Ultrafiltration trough peritoneal dialysis in refractory congestive heart failure patients: one center experience

Year 2020, Volume: 2 Issue: 4, 118 - 122, 29.10.2020

Ayşegül Oruç Mehmet Fethullah Aydın Abdulmecit Yildiz Mahmut Yavuz Mustafa Güllülü Kamil Dilek Alparslan Ersoy

https://doi.org/10.46310/tjim.768289

Abstract

Background:
Hypervolemia is an important consequence of heart failure (HF) that leads to poor quality of life and frequent hospitalizations. Ultrafiltration (UF) with dialysis is an option for HF patients who are resistant or inappropriate for diuretics. Peritoneal dialysis (PD) can be a long-term efficient solution for hypervolemia in appropriate HF patients.
Material and Methods:
We retrospectively evaluated PD patients in our center in order to determine the ones whose indication was UF for volume control because of HF between January 2015 and January 2020.
Results:
4 (2 females, 68.75±4.27 years old) HF patients who had a poor volume control on diuretic based regimen were on PD for UF. PD treatment was planned as a daily single exchange with icodextrin in whom all had preserved renal function. In one patient one daily exchange with an amino acid-based PD solution was added. The exchange volume was between 1000 and 1500 mL, dwell time was 9 to 14 hours, and UF was 200 to 1100 mL. During the follow-up, patients lost adequate weight and none of them were hospitalized because of hypervolemia.
Conclusions:
UF through PD in HF patients provides effective volume control, relief of symptoms, and avoids frequent hospitalizations. A single daily exchange with icodextrin can be adequate for hypervolemic, well-selected HF patients.

Keywords

ULTRAFILTRATION, PERITONEAL DIALYSYS, HEART FAILURE

References

• Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V; ESC Scientific Document Group. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016 Jul 14;37(27):2129-200. doi: 10.1093/eurheartj/ehw128.
• Puttagunta H, Holt SG. Peritoneal Dialysis for Heart Failure. Perit Dial Int. 2015 Nov;35(6):645-9. doi: 10.3747/pdi.2014.00340.
• Hollenberg SM, Warner Stevenson L, Ahmad T, Amin VJ, Bozkurt B, Butler J, Davis LL, Drazner MH, Kirkpatrick JN, Peterson PN, Reed BN, Roy CL, Storrow AB. 2019 ACC Expert Consensus Decision Pathway on Risk Assessment, Management, and Clinical Trajectory of Patients Hospitalized With Heart Failure: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2019 Oct 15;74(15):1966-2011. doi: 10.1016/j.jacc.2019.08.001.
• Schneierson SJ. Continuous peritoneal irrigation in the treatment of intractable edema of cardiac origin. Am J Med Sci. 1949 Jul;218(1):76-9. doi: 10.1097/00000441-194907000-00011.
• Costanzo MR, Saltzberg M, O'Sullivan J, Sobotka P. Early ultrafiltration in patients with decompensated heart failure and diuretic resistance. J Am Coll Cardiol. 2005 Dec 6;46(11):2047-51. doi: 10.1016/j.jacc.2005.05.099.
• Costanzo MR, Guglin ME, Saltzberg MT, Jessup ML, Bart BA, Teerlink JR, Jaski BE, Fang JC, Feller ED, Haas GJ, Anderson AS, Schollmeyer MP, Sobotka PA; UNLOAD Trial Investigators. Ultrafiltration versus intravenous diuretics for patients hospitalized for acute decompensated heart failure. J Am Coll Cardiol. 2007 Feb 13;49(6):675-83. doi: 10.1016/j.jacc.2006.07.073.
• Bart BA, Goldsmith SR, Lee KL, Givertz MM, O'Connor CM, Bull DA, Redfield MM, Deswal A, Rouleau JL, LeWinter MM, Ofili EO, Stevenson LW, Semigran MJ, Felker GM, Chen HH, Hernandez AF, Anstrom KJ, McNulty SE, Velazquez EJ, Ibarra JC, Mascette AM, Braunwald E; Heart Failure Clinical Research Network. Ultrafiltration in decompensated heart failure with cardiorenal syndrome. N Engl J Med. 2012 Dec 13;367(24):2296-304. doi: 10.1056/NEJMoa1210357.
• Basile C, Chimienti D, Bruno A, Cocola S, Libutti P, Teutonico A, Cazzato F. Efficacy of peritoneal dialysis with icodextrin in the long-term treatment of refractory congestive heart failure. Perit Dial Int. 2009 Jan-Feb;29(1):116-8.
• Selby NM, Kazmi I. Peritoneal dialysis has optimal intradialytic hemodynamics and preserves residual renal function: Why isn't it better than hemodialysis? Semin Dial. 2019 Jan;32(1):3-8. doi: 10.1111/sdi.12752.
• Ellison DH. Diuretic therapy and resistance in congestive heart failure. Cardiology. 2001;96(3-4):132-43. doi: 10.1159/000047397.
• Nakayama M, Nakano H, Nakayama M. Novel therapeutic option for refractory heart failure in elderly patients with chronic kidney disease by incremental peritoneal dialysis. J Cardiol. 2010 Jan;55(1):49-54. doi: 10.1016/j.jjcc.2009.08.003.
• Chionh CY, Clementi A, Poh CB, Finkelstein FO, Cruz DN. The use of peritoneal dialysis in heart failure: A systematic review. Perit Dial Int. 2020 Jan 13:896860819895198. doi: 10.1177/0896860819895198.
• Li PK, Szeto CC, Piraino B, de Arteaga J, Fan S, Figueiredo AE, Fish DN, Goffin E, Kim YL, Salzer W, Struijk DG, Teitelbaum I, Johnson DW. ISPD Peritonitis Recommendations: 2016 Update on Prevention and Treatment. Perit Dial Int. 2016 Sep 10;36(5):481-508. doi: 10.3747/pdi.2016.00078.
• Bertoli SV, Musetti C, Ciurlino D, Basile C, Galli E, Gambaro G, Iadarola G, Guastoni C, Carlini A, Fasciolo F, Borzumati M, Gallieni M, Stefania F. Peritoneal ultrafiltration in refractory heart failure: a cohort study. Perit Dial Int. 2014 Jan-Feb;34(1):64-70. doi: 10.3747/pdi.2012.00290.