Related Experiment Video
Updated: Aug 16, 2026
A Retrograde Implantation Approach for Peritoneal Dialysis Catheter Placement in Mice
Published on: July 20, 2022
Peritoneal dialysis in refractory end-stage congestive heart failure: a challenge facing a no-win situation
Lazaro Gotloib1, Roberto Fudin, Michaela Yakubovich
1Center for Experimental Nephrology, Ha'Emek Medical Center, Afula 18101, Israel. gotloib@012.net.il
Insights
Automated peritoneal dialysis (APD) offers a promising treatment for severe congestive heart failure (CHF) in elderly patients ineligible for transplantation. This therapy improved cardiac function and reduced hospitalizations, suggesting a new therapeutic avenue for refractory CHF.
Area of Science:
- Nephrology
- Cardiology
- Geriatrics
Background:
- Refractory congestive heart failure (CHF) in elderly patients (65+) with contraindications for heart transplantation has limited treatment options.
- Peritoneal dialysis has shown potential for improving cardiac function in CHF patients, even those with renal impairment.
Purpose of the Study:
- To evaluate the efficacy of automated peritoneal dialysis (APD) as a therapeutic strategy for severe, refractory congestive heart failure (CHF) in elderly patients.
Main Methods:
- A prospective, non-randomized study involving 20 elderly patients (mean age 65.7) with NYHA class IV CHF and ejection fraction <35%.
- Patients initially received continuous veno-venous haemofiltration (CVVH) or sequential haemofiltration (SHF), followed by APD (3 sessions/week for 8 hours).
- The study included patients with significant comorbidities, including diabetes and impaired renal function (GFR 14.84 ml/min).
Main Results:
- Significant hemodynamic improvements were observed, including enhanced left cardiac work index and reduced systolic time ratio.
- Thoracic fluid content decreased, and patients improved from NYHA class IV to class I.
- Hospitalizations for CHF decreased dramatically from 157 to 13 days over the follow-up period (mean 19.8 months).
Conclusions:
- Automated peritoneal dialysis (APD) shows promise as a therapeutic option for refractory congestive heart failure (CHF).
- Clinical improvements may stem from the clearance of myocardial depressant substances.
- Further prospective, multicenter trials are necessary to validate these findings.
Background:
Current medical therapeutic strategies for refractory congestive heart failure (CHF) in the population of 65 years and older with contraindications for heart transplantation are limited. Peritoneal dialysis applied to CHF patients with or without renal impairment showed clinical functional improvement.
Methods:
A single centre, prospective but non-randomized study in 20 patients with severe congestive heart failure refractory to optimal pharmacological therapy [New York Heart Association (NYHA), class IV] was performed between 2000 and 2003. The mean age was 65.71+/-7.66 years. The patients had a baseline glomerular filtration rate of 14.84+/-3.8 ml/min. Fifteen patients were diabetics (type I, 10; type II, five). For all patients, the baseline ejection fraction was <35% (31.2+/-4.7%). The mean Charlson's co-morbidity index was 7.8+/-1.8. Patients were treated initially by 2-5 sessions of continuous veno-venous haemofiltration (CVVH) or sequential haemofiltration (SHF). Automated peritoneal dialysis (APD) was started after implantation of a Tenckhoff catheter. Three APD sessions/week (8 h each), with 15-20 l of dialysis fluid (PDF) per session (10.35+/-3.05 l of 1.5% lactated glucose and 8.95 +/-2.95 l of 4.25% glucose PDF), were performed. Total follow-up ranged between 7 and 35 months (mean 19.80+/-7.37).
Results:
After 1 year of follow-up, all patients showed haemodynamic improvement: significant improvement of left cardiac work index (2.33+/-0.69 to 2.59+/-0.47 kg min/m(2)), reduction of the systolic times ratio (61.14+/-12.57 to 39.18+/-13.44%), lower thoracic fluid contents (0.04+/-0.005 to 0.003+/-0.0001 Omega) as well as a regression from NYHA class IV to class I. Need for hospitalization for CHF decreased from 157 to 13 days.
Conclusions:
Peritoneal dialysis appears to be a promising therapeutic tool for patients affected by refractory CHF. Clinical improvement of cardiac function may be related to clearing blood from middle molecular weight myocardial depressant substances, including atrial natriuretic peptide. Prospective multicentre trials are needed to confirm these encouraging results.
Related Concept Videos
01:25Peritoneal Dialysis II: Peritoneal Dialysis Systems and Complications
01:27Dialysis
Acute kidney injury develops suddenly and can be caused by pre-renal causes (e.g., hypovolemia, shock), intrinsic renal causes (e.g., acute tubular necrosis), or post-renal causes (e.g., urinary obstruction). In contrast, chronic renal failure progresses gradually over time and is often...
01:30Extracorporeal Removal of Drugs: Peritoneal Dialysis and Hemodialysis
01:30Peritoneal Dialysis I: Introduction and Procedure
01:25Peritoneal Dialysis III: Nursing Management
01:24Hemodialysis II: Procedure and Complications