Peritoneal Dialysis: An Optimal Technique for Supporting Dialysis Patients with Heart Failure

Introduction: The primary indication for peritoneal dialysis remains end- stage renal disease. However, over the last thirty years, a second indication has emerged for the management of congestive heart failure. The aim of this prospective study was to evaluate the impact of this modality on cardiac function. Patients and Methods: This study was initiated in January 2013 in patients with chronic kidney failure on peritoneal dialysis. The following parameters were studied in patients meeting the inclusion criteria: age, sex, initial nephropathy, Charlson comorbidity index, functional signs of heart failure, heart failure score, number and type of antihypertensive agents, residual diuresis, and quantification of daily ultrafiltration. All patients underwent echocardiography 6 months after initiation of peritoneal dialysis. Results: Twenty-eight patients out of 161 met the inclusion criteria, comprising 11 women and 17 men, with a mean age of 51.62 years (range: 8–69 years). The distribution of initial nephropathy was as follows: hypertensive nephropathy in 5 patients (18%), diabetic nephropathy in 13 patients (46.5%), hereditary nephropathy in 2 patients (7%), primary nephropathy in 1 patient (3.5%), secondary nephropathy in 2 patients (7%), malformative uropathy in 2 patients (7%), and indeterminate in 3 patients (10.5%). All patients had been on peritoneal dialysis for more than 10 months. Heart failure was systolic in 15 patients (53.5%), diastolic in 12 patients (42.8%), and unspecified in 1 patient (3.5%). Six patients were on automated peritoneal dialysis and 22 patients on continuous ambulatory peritoneal dialysis. The Charlson score was above 7 in 8 patients (28.5%), between 5 and 7 in 11 patients (39%), and below 5 in 9 patients (32.5%). Five patients had hyponatremia. Residual diuresis ranged from 100 mL to 2000 mL. All patients with residual diuresis were on 1 g of furosemide, and 2 patients were anuric and required a hypertonic bag (40 g/L glucose) per day for peritoneal dialysis. After 6 months on peritoneal dialysis, 60% of patients had their dry weight decreased by more than 6 kg, and there was significant improvement in left ventricular ejection fraction, which increased from 46% to 57% (p < 0.01). Discussion: Heart failure remains underutilized as an indication for peritoneal dialysis despite its potential advantages. Peritoneal dialysis can effectively remove volume, often with greater hemodynamic stability than intermittent hemodialysis. It additionally avoids the risk of systemic bloodstream infection, which may be particularly high risk for patients with cardiac devices. A systematic review of studies demonstrated that after peritoneal dialysis, hospitalization days declined significantly, heart function improved significantly (left ventricular ejection fraction and New York Heart Association classification), and body weight decreased significantly. Conclusion: The use of peritoneal dialysis to manage congestive symptoms in heart failure in end-stage renal disease remains a common practice. All end-stage renal disease patients with signs of heart intolerance in hemodialysis and ejection fraction below 50% were recruited for peritoneal dialysis. The results we have achieved and the experience accumulated over the years predict a broadening of the indication for peritoneal dialysis in heart failure patients without severe renal impairment.