Peritoneal dialysis in congestive heart failure: reflections from a patient with arrhythmogenic right ventricular cardiomyopathy

After multiple hospitalisations for diuretic-resistant acute decompensated heart failure (ADHF), an early 60s man with isolated right-sided heart failure due to arrhythmogenic right ventricular cardiomyopathy (ARVC) underwent continuous venovenous haemofiltration without lasting success. His blood urea nitrogen/creatinine ratio was high and renal blood flow and filtration fraction were low, indicative of the underlying cardiorenal dysbalance. Peritoneal dialysis (PD) was initiated because this form of renal replacement therapy provides better haemodynamic stability and a flexible schedule. This allowed the patient to maintain his professional activities and spend time with his family for the subsequent 7 months. Following a diabetic foot infection, his condition worsened, leading to his death. Autopsy showed fibrofatty replacement of the right ventricle and chronic ischaemic nephropathy, without signs of hypertensive or diabetic nephropathy.Although ARVC is rare, this case underscores the potential benefits of PD as a palliative option in end-stage heart failure. Early consideration of PD, particularly when other renal replacement therapies are limited or contraindicated, may alleviate symptoms and enhance quality of life, especially after repeated hospitalisations for heart failure and kidney injury. Collaborative care between cardiologists and nephrologists is essential for optimising management in these patients.