[Treatment of refractory congestive cardiac insufficiency by continuous peritoneal dialysis. Long-term course]

Continuous and progressive fluid removal was performed by continuous peritoneal dialysis in 19 patients (14 men, 5 women, mean age 60.7 years) suffering from refractory congestive heart failure. All patients were in NYHA class IV and had a life-threatening fluid overload. Twelve had normal renal function or functional renal failure, and 7 had organic renal failure. The continuous peritoneal dialysis technique with a high K+ concentration in the dialysate did not raise any particular problem. Mean survival of the whole group was 7.1 months. This figure rose to 16 months (rang 2-51 months) in the patients who survived at the end of the first month. Sixteen out of 19 patients eventually died, most of them suddenly and probably of ventricular arrhythmia. Nine patients were discharged on continuous ambulatory peritoneal dialysis and remained on it for 2 to 48 months. Drug therapy could be reduced in all cases. Dialysis was discontinued in 5 patients without organic renal failure who thereafter survived for a mean period of 5 months. Functional improvement and duration of survival were uncorrelated with heart disease, fluid overload, initial renal function or initial left ventricular ejection fraction. A cardiothoracic ratio greater than 0.70 and the need for mechanical ventilation seemed to be of poor prognosis. Such results justify the pursuit of this study before defining selection criteria.