The Role of Peritoneal Dialysis in Patients With Refractory Heart Failure and Chronic Kidney Disease
Status:
Completed
Trial end date:
2015-10-08
Target enrollment:
Participant gender:
Summary
In patients with advanced heart failure (HF), systemic congestion is the main indication for
hospitalization. Recent evidence has highlighted the role of fluid retention in the
pathogenesis of renal dysfunction and subsequent diuretic resistance. Previous kidney
disease, diuretic resistance, and progression of renal dysfunction often coexist in patients
with HF and persistent volume overload. This clinical presentation represents the most
extreme feature of the cardio-renal syndrome. However, available therapeutic options for this
ominous condition are scarce and limited. Indeed, there are no data from randomized control
trials using pharmacological interventions that support the beneficial effect on survival.
Interestingly, intermittent ultrafiltration has recently emerged as an alternative
therapeutic option for reducing volume overload in patients with refractory HF. Current
literature suggests that it has potential advantages over standard medical treatment
particularly in acute stages of HF. Among ultrafiltration methods, peritoneal dialysis (PD)
has been preferred as an additional resource for the treatment of advanced congestive heart
failure (CHF) compared with hemodialysis because it can provide a more physiological and
continuous ultrafiltration. In fact, several studies showed that use of PD improved clinical
functional class and hemodynamic parameters and reduced hospitalization rates in patients
with CHF. Nevertheless, most studies were limited by retrospective analyses of small sample
size, prospective observational design with no control group, or inclusion of patients with
end-stage renal failure. Therefore, well-designed prospective randomized controlled studies
are mandatory to confirm the effects of PD in these patients.