Role of peritoneal dialysis as a chronic renal replacement therapy in cardiorenal patients

The cardiorenal syndrome (CRS) is a pathophysiological condition characterized by a simultaneous combination of cardiac and renal dysfunction. When diuretic resistance occurs, fluid removal by ultrafiltration (UF) is beneficial. However, in progressive CRS type II multiple hospitalizations for intravenous therapy or extracorporeal UF due to recurrent decompensations have important implications in the deterioration of quality of life and in the use of hospital resources. Peritoneal daily sustained UF appears to be a good therapeutic tool for the chronic ambulatory management of these patients avoiding the risks of a central venous access, aggressive volume shifts and the circulatory stress of the extracorporeal techniques. Controversies on the results of peritoneal dialysis in cardiorenal patients are mostly dependent on therapy skills since individuals with heart failure have a narrower window of tolerance, presenting significant complications even in presence of small deviations from optimal fluid balance. The updated use of volume monitoring tools is recommended. Multifrequency bioimpedance allows detailed information on the total body water overload and, more importantly on the extracellular/intracellular water distribution. This is an instrument that can be longitudinally used to improve the accuracy of clinical judgment concerning volume status. Incremental PD with use of icodextrine besides the promising role of low sodium solutions and bimodal solutions are therapy issues that can improve clinical outcomes of cardio-renal patients under peritoneal dialysis, as a home-based continuous therapy.