Peritoneal dialysis for chronic cardiorenal syndrome: Lessons learned from ultrafiltration trials

Table 1 Proposed benefits of peritoneal dialysis therapy for heart failure

Continuous gentle ultrafiltration with minimal impact on hemodynamic status

Improvement in functional status and symptoms of volume overload

Reduction in number of days of heart failure-related hospitalizations

Restoration of diuretic responsiveness

Reduction in weight and improvement in volume status

Improvement in left ventricular ejection fraction

Sodium sieving effect and possibility of better control of natremia

Removal of pro-inflammatory mediators (medium-sized molecules)

Reduction in intra-abdominal pressure in patients with severe ascites

Improvement in quality of life

Improved atherogenic lipid serum profile

Lack of impact on neurohormonal activity (renin-angiotensin-aldosterone system and sympathetic nervous system)

Improved control of serum potassium level (hence providing the opportunity to use medications such as aldosterone receptor blockers)

Reduction in healthcare cost

Adapted from Courivaud et al[9], with permission.

Table 2 Selected studies on the role of peritoneal dialysis in heart failure

Ref.	Study design	No. of patients	Mean age(yr)	Male gender	NYHA class	EF	Renal function	Main findings	Comment
Koch et al[11]	Prospective	118	73.2	60.2%	III (49.2%)	43.5%	Creatinine clearance 19.2 mL/min	Significant improvement in body	Negligible incidence of peritonitis and catheter dysfunction
					IV (50.8%)			Weight and NYHA class
Núñez et al[8]	Prospective	25	75.1	72%	III or IV (100%)	40%	eGFR 33 mL/min per 1.73 m2	Significant improvement in patients’ clinical status and NYHA class	Marked reduction in the number of days hospitalized for acute heart failure
Bertoli et al[12]	Multicenter retrospective	48	74	81%	II (6%)	30%	eGFR 21 mL/min per 1.73 m2	Significant improvement in NYHA class and reduction in the number of days hospitalized	Significant reduction in pulmonary artery pressure and improvement in EF
					III (48%)
					IV (46%)
Courivaud et al[10]	Retrospective	126	72	69%	N/A	38%	eGFR 33.5 mL/min per 1.73 m2	Significant reduction in the number of days hospitalized for acute heart failure	Improvement in cardiac function in patients with a an EF of 30% or less

NYHA: New York Heart Association.