Peritoneal dialysis in patients with congestive heart failure

Peritoneal dialysis (PD) may be a useful technique in the treatment of patients with congestive heart failure, both with and without primary end-stage renal disease (ESRD).

In the treatment of patients with ESRD and congestive heart failure (CHF), PD has theoretical advantages compared with haemodialysis (HD), such as the absence of an arteriovenous fistula and the more gradual fluid removal. In cohort studies, the incidence of heart failure was less as compared with HD, however, randomized studies on this aspect are lacking.

As an acute rescue treatment of patients with treatment refractory heart failure, functional improvement has been observed with the use of PD. However, fluid removal is less predictable compared with continuous haemofiltration therapies.

As a long-term option for patients with treatment refractory CHF without ESRD, various case series showed improved functional performance and a reduction in hospitalization with the use of PD. However, also with the use of PD, median survival is still limited in these patients. Randomized studies are needed to establish the potential role of PD for this indication.