Peritoneal ultrafiltration in patients with advanced decompensated heart failure

Area of Science:

• Nephrology
• Cardiology
• Internal Medicine

Background:

• Treatment-resistant advanced decompensated heart failure (TR-AHDF) presents severe symptoms despite maximal medical and surgical interventions.
• Patients with TR-AHDF often have coexisting chronic kidney disease, complicating management.
• Extracorporeal ultrafiltration methods like SCUF and CRRT require hospitalization.

Purpose of the Study:

• Establish best practice guidelines for peritoneal ultrafiltration (PUF) in TR-AHDF patients.
• Promote standardized management and interdisciplinary collaboration between nephrologists and cardiologists.
• Define criteria and methods for considering PUF in specific TR-AHDF patient populations.

Main Methods:

• Review of existing literature and case series on PUF in decompensated heart failure.
• Identification of patient selection criteria for PUF, including heart failure stage and kidney function.
• Description of PUF treatment modalities, including manual/automated peritoneal dialysis and fluid exchange variations.

Main Results:

• Peritoneal ultrafiltration (PUF) is a viable option for selected TR-AHDF patients with Stage D heart failure, INTERMACS Level 4, frequent flyer status, and CKD Stage 3.
• Specific PUF protocols, including varying glucose concentrations and icodextrin exchanges, are adapted from existing regimens.
• Guidelines emphasize a minimum follow-up testing set and the crucial role of integrated nephrology and cardiology care.

Conclusions:

• Peritoneal ultrafiltration (PUF) provides an alternative treatment strategy for refractory decompensated heart failure with renal compromise.
• Standardized guidelines and collaborative care are essential for optimizing PUF outcomes in this complex patient group.
• Further research and standardization of case series are needed to solidify PUF's role in TR-AHDF management.