Peritoneal dialysis in congestive heart failure

Heart failure is a major and growing health problem. Major advances leading to newer therapies are being made in understanding the pathophysiology of heart failure as a chronic progressive disorder. Whatever the cause, all heart failure patients eventually progress to a refractory stage characterized by worsening renal function and resistance to diuretic therapy with attending severe edema. A logical treatment for this "cardiorenal syndrome" is the use of dialysis, which is efficient in treating both the hypervolemia and azotemia of refractory heart failure. Although all modalities of dialysis have been tried, peritoneal dialysis (PD) is the simplest choice and offers several advantages. It is an already-established long-term home-based therapy and does not require complex machinery or hospital resources. It is associated with preservation of residual renal function, gentle continuous ultrafiltration, hemodynamic stability, better middle-molecule clearance, sodium sieving with maintenance of normonatremia and perhaps less inflammation than hemodialysis is, especially with newer PD solutions. In the present paper, we discuss the potential advantages of PD in the treatment of heart failure, review the available literature, and lay some foundations for future research.