This case illustrates a progressive, multidisciplinary approach to managing refractory fluid overload in heart failure complicated by renal insufficiency, culminating in chronic peritoneal dialysis.
Multidisciplinary escalation to peritoneal dialysis may be considered in refractory cardiorenal syndrome; single-case data leave open efficacy and safety.
A case of refractory fluid overload due to congestive heart failure and consequent renal insufficiency is reported. The case was approached multidisciplinarily, at the beginning with conservative and pharmacological therapy, subsequently with extracorporeal fluid removal in which a specific attention was payed to the maintenance of circulating blood volume and achievement of dry weight, and finally with chronic peritoneal dialysis as a maintenance therapy. The case seems to summarize the pathway of many patients seen initially in intensive care and cardiology departments and subsequently in nephrological wards.
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Salvatori et al. (2006) studied this question.
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