Aim: This study aimed to explore the role of peritoneal ultrafiltration (UF) in cardiorenal syndrome (CRS) patients for fluid and metabolic control. Background: Peritoneal UF is safely and efficiently used for the management of CRS. It has been shown to provide efficient UF in hypervolemic patients. Methods: Thirty (20 males and 10 females) CRS patients were treated by peritoneal dialysis (PD) and UF. The baseline data of the patients (demographics, causes of heart failure, the presence of pacemaker or implantable cardioverter-defibrillator, the need for extracorporeal UF or paracentesis or thoracentesis, comorbidity, drugs, left ventricular ejection fraction [LVEF] and pulmonary artery systolic pressure [PAPs], pericardial effusion, physical examination, body weight, NYHA class, dialysis regime, urine output, N-terminal pro-B-type natriuretic peptide [NT-proBNP] level, hemoglobin, estimated glomerular filtration rate [eGFR], and other routine biochemical determinations) were recorded at the onset, every 6 months, and then annually. Echocardiograms were performed at baseline and after 6 and 12 months. The time points of complications associated with PD, the need for hemodialysis, the day of death, and causes of death were documented. Results: Mean age was 69 ± 8 years (range 49–84 years). The average PD duration was 18.25 ± 14.87 months. According to the CKD-EPI, initial mean GFR was 34.34 ± 11.9 mL/min/1.73 m2 (range 16.57–59.0), and this increased to 45.48 ± 26.04, 45.10 ± 28.58, and 41.10 ± 25.68 mL/min/1.73 m2 in the third, sixth, and twelfth months, respectively. There was a significant increase in the first 3 months and a significant decrease between the third and twelfth months (respectively, p = 0.018 and p = 0.043). There was no difference in eGFR levels between baseline and the end of the first year (p = 0.217). In the first 3 months, there was a significant decline in urea levels to 79.38 ± 36.65 from 109.92 ± 42.44 mg/dL and this was maintained until the end of the first year of PD therapy (after 3 months, p = 0.002; after 1 year, p = 0.024). However, there was no significant change in creatinine levels within the first year (p = 0.312). There was a significant increase in hemoglobin level up to the end of the first year of PD (after 3 months, p = 0.000; after 12 months, p = 0.013). There was a marked decrease in NT-proBNP levels in the first 6 months (p = 0.011). Functional capacity (according to NYHA classification) improved in all patients by the third month of PD treatment (p < 0.001). This early improvement was maintained in many patients during the following 12 months (p < 0.001). There was a marked decrease in NT-proBNP levels in the first 6 months (p = 0.011). At the end of the first year, there was an approximate 15% reduction in NT-proBNP levels (p = 0.647). Hospitalizations decreased to 6 ± 15 days/patient-year (range 18–122 days) from 62 ± 24 days/patient-year (p = 0.000). Conclusion: Peritoneal UF is a treatment method that maintains renal function and electrolyte balance, improves cardiac function, and reduces hospitalizations in CRS patients. We observed that this treatment significantly increased functional capacity and quality of life and significantly reduced hospital admissions.

1.
Ronco
C
,
McCullough
P
,
Anker
SD
,
Anand
I
,
Aspromonte
N
,
Bagshaw
SM
, et al;
Acute Dialysis Quality Initiative (ADQI) consensus group
.
Cardio-renal syndromes: report from the consensus conference of the acute dialysis quality initiative
.
Eur Heart J
.
2010
Mar
;
31
(
6
):
703
11
.
[PubMed]
0195-668X
2.
Bart
BA
,
Goldsmith
SR
,
Lee
KL
,
Redfield
MM
,
Felker
GM
,
O’Connor
CM
, et al
Cardiorenal rescue study in acute decompensated heart failure: rationale and design of CARRESS-HF, for the Heart Failure Clinical Research Network
.
J Card Fail
.
2012
Mar
;
18
(
3
):
176
82
.
[PubMed]
1071-9164
3.
Costanzo
MR
,
Negoianu
D
,
Jaski
BE
, et al
Aquapheresis Versus Intravenous Diuretics and Hospitalizations for Heart Failure.
2016
.
4.
Schneierson
SJ
.
Continuous peritoneal irrigation in the treatment of intractable edema of cardiac origin
.
Am J Med Sci
.
1949
Jul
;
218
(
1
):
76
9
.
[PubMed]
0002-9629
5.
Clementi
A
,
Virzì
GM
,
Brocca
A
,
de Cal
M
,
Vescovo
G
,
Granata
A
, et al
Cardiorenal syndrome type 4: management
.
Blood Purif
.
2013
;
36
(
3-4
):
200
9
.
[PubMed]
0253-5068
6.
Cruz
DN
,
Schmidt-Ott
KM
,
Vescovo
G
,
House
AA
,
Kellum
JA
,
Ronco
C
, et al
Pathophysiology of cardiorenal syndrome type 2 in stable chronic heart failure: workgroup statements from the eleventh consensus conference of the Acute Dialysis Quality Initiative (ADQI)
.
Contrib Nephrol
.
2013
;
182
:
117
36
.
[PubMed]
0302-5144
7.
François
K
,
Ronco
C
,
Bargman
JM
.
Peritoneal Dialysis for Chronic Congestive Heart Failure
.
Blood Purif
.
2015
;
40
(
1
):
45
52
.
[PubMed]
0253-5068
8.
Zemel
D
,
Imholz
AL
,
de Waart
DR
,
Dinkla
C
,
Struijk
DG
,
Krediet
RT
.
Appearance of tumor necrosis factor-alpha and soluble TNF-receptors I and II in peritoneal effluent of CAPD
.
Kidney Int
.
1994
Nov
;
46
(
5
):
1422
30
.
[PubMed]
0085-2538
9.
Chiarelli G, Beaulieu M, Taylor P, Levin A, Holmes DT. Elimination of BNP by peritoneal dialysis: investigation of analytical issues. Perit Dial Int. 31(2):199–202.
10.
Mullens
W
,
Abrahams
Z
,
Francis
GS
,
Taylor
DO
,
Starling
RC
,
Tang
WH
.
Prompt reduction in intra-abdominal pressure following large-volume mechanical fluid removal improves renal insufficiency in refractory decompensated heart failure
.
J Card Fail
.
2008
Aug
;
14
(
6
):
508
14
.
[PubMed]
1071-9164
11.
Lang
RM
,
Badano
LP
,
Mor-Avi
V
,
Afilalo
J
,
Armstrong
A
,
Ernande
L
, et al
Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging
.
Eur Heart J Cardiovasc Imaging
.
2015
Mar
;
16
(
3
):
233
70
.
[PubMed]
2047-2404
12.
Palazzuoli
A
,
Beltrami
M
,
Ruocco
G
,
Pellegrini
M
,
Nuti
R
.
The role of natriuretic peptides for the diagnosis of left ventricular dysfunction.
Sci World J.
2013
;2013.
13.
Lu
R
,
Muciño-Bermejo
MJ
,
Ribeiro
LC
,
Tonini
E
,
Estremadoyro
C
,
Samoni
S
, et al
Peritoneal dialysis in patients with refractory congestive heart failure: a systematic review
.
Cardiorenal Med
.
2015
Apr
;
5
(
2
):
145
56
.
[PubMed]
1664-3828
14.
Sánchez
JE
,
Ortega
T
,
Rodríguez
C
,
Díaz-Molina
B
,
Martín
M
,
Garcia-Cueto
C
, et al
Efficacy of peritoneal ultrafiltration in the treatment of refractory congestive heart failure
.
Nephrol Dial Transplant
.
2010
Feb
;
25
(
2
):
605
10
.
[PubMed]
0931-0509
15.
Bertoli
SV
,
Musetti
C
,
Ciurlino
D
,
Basile
C
,
Galli
E
,
Gambaro
G
, et al
Peritoneal ultrafiltration in refractory heart failure: a cohort study
.
Perit Dial Int
.
2014
Jan-Feb
;
34
(
1
):
64
70
.
[PubMed]
0896-8608
16.
Binanay
C
,
Califf
RM
,
Hasselblad
V
,
O’Connor
CM
,
Shah
MR
,
Sopko
G
, et al;
ESCAPE Investigators and ESCAPE Study Coordinators
.
Evaluation study of congestive heart failure and pulmonary artery catheterization effectiveness: the ESCAPE trial
.
JAMA
.
2005
Oct
;
294
(
13
):
1625
33
.
[PubMed]
0098-7484
17.
Cnossen
TT
,
Kooman
JP
,
Konings
CJ
,
Uszko-Lencer
NH
,
Leunissen
KM
,
van der Sande
FM
.
Peritoneal dialysis in patients with primary cardiac failure complicated by renal failure
.
Blood Purif
.
2010
;
30
(
2
):
146
52
.
[PubMed]
0253-5068
18.
Aronson
D
,
Burger
AJ
.
The relationship between transient and persistent worsening renal function and mortality in patients with acute decompensated heart failure
.
J Card Fail
.
2010
Jul
;
16
(
7
):
541
7
.
[PubMed]
1071-9164
19.
Costanzo
MR
,
Guglin
ME
,
Saltzberg
MT
,
Jessup
ML
,
Bart
BA
,
Teerlink
JR
, et al;
UNLOAD Trial Investigators
.
Ultrafiltration versus intravenous diuretics for patients hospitalized for acute decompensated heart failure
.
J Am Coll Cardiol
.
2007
Feb
;
49
(
6
):
675
83
.
[PubMed]
0735-1097
20.
Marenzi
G
,
Muratori
M
,
Cosentino
ER
,
Rinaldi
ER
,
Donghi
V
,
Milazzo
V
, et al
Continuous ultrafiltration for congestive heart failure: the CUORE trial
.
J Card Fail
.
2014
Jan
;
20
(
1
):
9
17
.
[PubMed]
1071-9164
21.
Courivaud
C
,
Kazory
A
,
Crépin
T
,
Azar
R
,
Bresson-Vautrin
C
,
Chalopin
JM
, et al
Peritoneal dialysis reduces the number of hospitalization days in heart failure patients refractory to diuretics
.
Perit Dial Int
.
2014
Jan-Feb
;
34
(
1
):
100
8
.
[PubMed]
0896-8608
22.
Shao
Q
,
Xia
Y
,
Zhao
M
,
Liu
J
,
Zhang
Q
,
Jin
B
, et al
Effectiveness and Safety of Peritoneal Dialysis Treatment in Patients with Refractory Congestive Heart Failure due to Chronic Cardiorenal Syndrome
.
BioMed Res Int
.
2018
May
;
2018
:
6529283
.
[PubMed]
2314-6133
23.
Koch
M
,
Haastert
B
,
Kohnle
M
, et al
Peritoneal dialysis relieves clinical symptoms and is well tolerated in patients with refractory heart failure and chronic kidney disease.
2012
:530-539.
24.
Nakayama
M
,
Nakano
H
,
Nakayama
M
.
Novel therapeutic option for refractory heart failure in elderly patients with chronic kidney disease by incremental peritoneal dialysis
.
J Cardiol
.
2010
Jan
;
55
(
1
):
49
54
.
[PubMed]
0914-5087
25.
Sheppard
R
,
Panyon
J
,
Pohwani
AL
,
Kapoor
A
,
Macgowan
G
,
McNamara
D
, et al
Intermittent outpatient ultrafiltration for the treatment of severe refractory congestive heart failure
.
J Card Fail
.
2004
Oct
;
10
(
5
):
380
3
.
[PubMed]
1071-9164
26.
Ryckelynck
JP
,
Lobbedez
T
,
Valette
B
,
Le Goff
C
,
Mazouz
O
,
Levaltier
B
, et al
Peritoneal ultrafiltration and refractory congestive heart failure
.
Adv Perit Dial
.
1997
;
13
:
93
7
.
[PubMed]
1197-8554
27.
Şenel
ET
,
Cebeci
E
,
Öztürk
S
.
S.Öztürk EC et all. Role of Pertioneal Ultrafiltration in Heart Failure Treatment
.
Med Bull Haseki.
2017
;
55
(
3
):
165
74
.
28.
McAlister
FA
,
Ezekowitz
J
,
Tonelli
M
,
Armstrong
PW
.
Renal insufficiency and heart failure: prognostic and therapeutic implications from a prospective cohort study
.
Circulation
.
2004
Mar
;
109
(
8
):
1004
9
.
[PubMed]
0009-7322
29.
Díez Ojea
B
,
Rodríguez Suárez
C
,
Vidau
P
,
Gago
E
,
Díaz Molina
B
,
Martín Fernández
M
, et al
[Peritoneal dialyisis role in heart failure treatment, experience in our center]
.
Nefrologia
.
2007
;
27
(
5
):
605
11
.
[PubMed]
0211-6995
30.
Fraenkel
PG
.
Anemia of Inflammation: A Review
.
Med Clin North Am
.
2017
Mar
;
101
(
2
):
285
96
.
[PubMed]
0025-7125
31.
Bleumink
GS
,
Knetsch
AM
,
Sturkenboom
MC
,
Straus
SM
,
Hofman
A
,
Deckers
JW
, et al
Quantifying the heart failure epidemic: prevalence, incidence rate, lifetime risk and prognosis of heart failure The Rotterdam Study
.
Eur Heart J
.
2004
Sep
;
25
(
18
):
1614
9
.
[PubMed]
0195-668X
32.
Hébert
MJ
,
Falardeau
M
,
Pichette
V
,
Houde
M
,
Nolin
L
,
Cardinal
J
, et al
Continuous ambulatory peritoneal dialysis for patients with severe left ventricular systolic dysfunction and end-stage renal disease
.
Am J Kidney Dis
.
1995
May
;
25
(
5
):
761
8
.
[PubMed]
0272-6386
33.
Gotloib
L
,
Fudin
R
,
Yakubovich
M
,
Vienken
J
.
Peritoneal dialysis in refractory end-stage congestive heart failure: a challenge facing a no-win situation
.
Nephrol Dial Transplant
.
2005
Jul
;
20
Suppl 7
:
vii32
6
.
[PubMed]
0931-0509
34.
Jessup
M
,
Brozena
S
.
Heart failure
.
N Engl J Med
.
2003
May
;
348
(
20
):
2007
18
.
[PubMed]
0028-4793
35.
Rose
EA
,
Gelijns
AC
,
Moskowitz
AJ
,
Heitjan
DF
,
Stevenson
LW
,
Dembitsky
W
, et al;
Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure (REMATCH) Study Group
.
Long-term use of a left ventricular assist device for end-stage heart failure
.
N Engl J Med
.
2001
Nov
;
345
(
20
):
1435
43
.
[PubMed]
0028-4793
36.
Núñez
J
,
González
M
,
Miñana
G
,
Garcia-Ramón
R
,
Sanchis
J
,
Bodí
V
, et al
Continuous ambulatory peritoneal dialysis as a therapeutic alternative in patients with advanced congestive heart failure
.
Eur J Heart Fail
.
2012
May
;
14
(
5
):
540
8
.
[PubMed]
1388-9842
37.
Patarroyo
M
,
Wehbe
E
,
Hanna
M
,
Taylor
DO
,
Starling
RC
,
Demirjian
S
, et al
Cardiorenal outcomes after slow continuous ultrafiltration therapy in refractory patients with advanced decompensated heart failure
.
J Am Coll Cardiol
.
2012
Nov
;
60
(
19
):
1906
12
.
[PubMed]
0735-1097
38.
Ross
EA
,
Kazory
A
.
Ultrafiltration therapy for cardiorenal syndrome: physiologic basis and contemporary options
.
Blood Purif
.
2012
;
34
(
2
):
149
57
.
[PubMed]
0253-5068
39.
Pavo
N
,
Yarragudi
R
,
Puttinger
H
,
Arfsten
H
,
Strunk
G
,
Bojic
A
, et al
Parameters associated with therapeutic response using peritoneal dialysis for therapy refractory heart failure and congestive right ventricular dysfunction
.
PLoS One
.
2018
Nov
;
13
(
11
):
e0206830
.
[PubMed]
1932-6203
40.
Ruhi
Ç
,
Koçak
H
,
Yavuz
A
,
Süleymanlar
G
,
Ersoy
FF
.
Use of peritoneal ultrafiltration in the elderly refractory congestive heart failure patients.
Int Urol Nephrol.
2012
. Jun;44(3):963-9.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.