Peritoneal ultrafiltration in refractory heart failure: A cohort study

Silvio V. Bertoli, Claudio Musetti, Daniele Ciurlino, Carlo Basile, Emilio Galli, Giovanni Gambaro, Gianmaria Iadarola, Carlo Guastoni, Antonio Carlini, Federica Fasciolo, Maurizio Borzumati, Maurizio Gallieni, Farina Stefania

Research output: Contribution to journalArticle

Abstract

Introduction: Acutely decompensated heart failure (HF) in patients with diuretic resistance is often treated with extracorporeal ultrafiltration. Peritoneal ultrafiltration (PUF) has been proposed for the long-term management of severe HF after resolution of the acute episode. The aim of the present study was to evaluate the use of PUF in the treatment of chronic refractory HF in patients without end-stage renal disease. Methods: This multicenter (10 nephrology departments throughout Italy) retrospective observational study included patients with severe HF refractory to maximized drug treatment. The patients were proposed for PUF because they had experienced at least 3 hospital admissions in the preceding year for acutely decompensated HF requiring extracorporeal ultrafiltration. Results: Of the 48 study patients (39 men, 9 women; mean age 74 ± 9 years), 30 received 1 nocturnal icodextrin exchange, 5 required 2 daily exchanges, and 13 received 2 – 4 sessions per week of automated peritoneal dialysis. During the first year, renal function remained stable (initial: 20.8± 10.0 mL/min/1.73 m2; end: 22.0 ± 13.6 mL/min/1.73 m2), while pulmonary artery systolic pressure declined to 40 ± 6.09 mmHg from 45.5 ± 9.18 mmHg (p = 0.03), with a significant concomitant improvement in New York Heart Association functional status. Hospitalizations decreased to 11 ± 17 days/patient–year from 43 ± 33 days/patient–year before the start of PUF (p <0.001). The incidence of peritonitis was 1 episode in 45 patient–months. Patient survival was 85% at 1 year and 56% at 2 years. Conclusions: This study confirms the satisfactory results of using PUF for chronic HF in elderly patients.

Original languageEnglish
Pages (from-to)64-70
Number of pages7
JournalPeritoneal Dialysis International
Volume34
Issue number1
DOIs
Publication statusPublished - 2014

Keywords

  • Heart failure
  • Patient survival
  • Peritoneal ultrafiltration
  • Sodium
  • Ultrafiltration

ASJC Scopus subject areas

  • Nephrology
  • Medicine(all)

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    Bertoli, S. V., Musetti, C., Ciurlino, D., Basile, C., Galli, E., Gambaro, G., Iadarola, G., Guastoni, C., Carlini, A., Fasciolo, F., Borzumati, M., Gallieni, M., & Stefania, F. (2014). Peritoneal ultrafiltration in refractory heart failure: A cohort study. Peritoneal Dialysis International, 34(1), 64-70. https://doi.org/10.3747/pdi.2012.00290