Peritoneal ultrafiltration: bridging the treatment gap to cardiac transplantation in refractory congestive heart failure management

Background: Peritoneal ultrafiltration needs consideration as a therapeutic option for improvement in echocardiographic parameters, tissue Doppler imaging, and patient clinical status in patients with refractory congestive heart failure.Methods: This prospective, non-randomised, two-year observational study from June 2012 to June 2014 included 19 clinic outpatients and in-patients admitted to the CARE hospital, Hyderabad. Baseline data was compared on initiation and after three months of ultrafiltration therapy. Out of 19 patients studied initially, 16 were alive and undergoing CAPD at 3 months.Results: 3 months post ultrafiltration, the ejection fraction (EF) improved significantly from 35.4±6.6 to 43.1±13.8 (p<0.01), right atrial volume index (RAVI) decreased significantly from 31.8±14.3 to 28.3±14.9 (P=0.016), inferior vena cava (IVC) diameter decreased significantly from 2.27±0.44 to 1.8±0.68 (P=0.01), pulmonary artery systolic pressure (PASP) decreased significantly from 50.7±14.4 mmHg to 38.1±15.6 mmHg (P<0.01), hospitalisation days decreased significantly from 17.5±8.3 to 1.7±3.4 days (P <0.0001) and the distance covered in the 6 minutes’ walk test (6MWT) increased significantly from 58.52 m±47.6 m to 176.4 m±80.7 m (p<0.0001). Except for 3 (17.6%) patients, significant patients that were NYHA class III and IV improved to NYHA class I and II (p <0.0001; Table 1).Conclusions: Ultrafiltration was safe and associated with significant improvements in echocardiographic parameters, NYHA functional class, physical performance (6MWT), and reduction of hospitalization days in patients with refractory congestive heart failure.