title: Peritoneal ultrafiltration in refractory heart failure: a cohort study.
abstract: BACKGROUND
  Acutely decompensated heart failure (HF) in patients with diuretic resistance is often treated with extracorporeal ultrafiltration. Peritoneal ultrafiltration (PUF) has been proposed for the long-term management of severe HF after resolution of the acute episode. The aim of the present study was to evaluate the use of PUF in the treatment of chronic refractory HF in patients without end-stage renal disease. ♢
  
  
  METHODS
  This multicenter (10 nephrology departments throughout Italy) retrospective observational study included patients with severe HF refractory to maximized drug treatment. The patients were proposed for PUF because they had experienced at least 3 hospital admissions in the preceding year for acutely decompensated HF requiring extracorporeal ultrafiltration. ♢
  
  
  RESULTS
  Of the 48 study patients (39 men, 9 women; mean age 74 ± 9 years), 30 received 1 nocturnal icodextrin exchange, 5 required 2 daily exchanges, and 13 received 2 - 4 sessions per week of automated peritoneal dialysis. During the first year, renal function remained stable (initial: 20.8 ± 10.0 mL/min/1.73 m(2); end: 22.0 ± 13.6 mL/min/1.73 m(2)), while pulmonary artery systolic pressure declined to 40 ± 6.09 mmHg from 45.5 ± 9.18 mmHg (p = 0.03), with a significant concomitant improvement in New York Heart Association functional status. Hospitalizations decreased to 11 ± 17 days/patient-year from 43 ± 33 days/patient-year before the start of PUF (p < 0.001). The incidence of peritonitis was 1 episode in 45 patient-months. Patient survival was 85% at 1 year and 56% at 2 years. ♢
  
  
  CONCLUSIONS
  This study confirms the satisfactory results of using PUF for chronic HF in elderly patients.
authors.affiliation: Cardiovascular Department,1 Renal Unit, IRCCS Multimedica, Milan;
authors.forename: Silvio V
authors.initials: SV
authors.lastname: Bertoli
authors.forename: Claudio
authors.initials: C
authors.lastname: Musetti
authors.forename: Daniele
authors.initials: D
authors.lastname: Ciurlino
authors.forename: Carlo
authors.initials: C
authors.lastname: Basile
authors.forename: Emilio
authors.initials: E
authors.lastname: Galli
authors.forename: Giovanni
authors.initials: G
authors.lastname: Gambaro
authors.forename: Gianmaria
authors.initials: G
authors.lastname: Iadarola
authors.forename: Carlo
authors.initials: C
authors.lastname: Guastoni
authors.forename: Antonio
authors.initials: A
authors.lastname: Carlini
authors.forename: Federica
authors.initials: F
authors.lastname: Fasciolo
authors.forename: Maurizio
authors.initials: M
authors.lastname: Borzumati
authors.forename: Maurizio
authors.initials: M
authors.lastname: Gallieni
authors.forename: Farina
authors.initials: F
authors.lastname: Stefania
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006440:Hemofiltration; D006801:Humans; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis; D012189:Retrospective Studies
keywords: Heart failure; patient survival; peritoneal ultrafiltration; sodium; ultrafiltration