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Published on: July 28, 2018
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Peritoneal ultrafiltration in refractory heart failure: a cohort study
Silvio V Bertoli1, Claudio Musetti, Daniele Ciurlino
1Cardiovascular Department,1 Renal Unit, IRCCS Multimedica, Milan;
Summary
Peritoneal ultrafiltration (PUF) effectively manages chronic refractory heart failure (HF) in elderly patients without end-stage renal disease. This treatment improved pulmonary artery pressure and reduced hospitalizations, demonstrating satisfactory patient outcomes.
Area of Science:
- Cardiology
- Nephrology
- Internal Medicine
Background:
- Acutely decompensated heart failure (HF) with diuretic resistance often requires extracorporeal ultrafiltration.
- Peritoneal ultrafiltration (PUF) is a potential long-term management strategy for severe HF post-acute episode.
Purpose of the Study:
- To evaluate the efficacy of PUF in treating chronic refractory HF in patients without end-stage renal disease.
Main Methods:
- Retrospective observational study across 10 Italian nephrology departments.
- Included patients with severe HF refractory to maximal drug therapy and at least 3 hospital admissions in the prior year for acute decompensation requiring ultrafiltration.
- Patients underwent various PUF regimens, including nocturnal icodextrin exchanges or automated peritoneal dialysis.
Main Results:
- Renal function remained stable during the first year of PUF.
- Pulmonary artery systolic pressure significantly decreased (45.5 to 40 mmHg), with improved New York Heart Association functional status.
- Hospitalizations reduced significantly (43 to 11 days/patient-year), with a low peritonitis incidence (1 per 45 patient-months).
- Patient survival was 85% at 1 year and 56% at 2 years.
Conclusions:
- PUF demonstrates satisfactory outcomes for managing chronic heart failure in elderly patients without end-stage renal disease.
- The study supports PUF as a viable treatment option for this patient population.
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