title: Peritoneal ultrafiltration in patients with advanced decompensated heart failure.
abstract: The aim of the Best Practice guidelines on peritoneal ultrafiltration (UF) in patients with treatment-resistant advanced decompensated heart failure (TR-AHDF) is to achieve a common approach to the management of decompensated heart failure in those situations in which all conventional treatment options have been unsuccessful, and to stimulate a closer cooperation between nephrologists and cardiologists. The standardization of the case series of different centers would allow a better definition of the results published in the literature, without which they are nothing more than anecdotes. TR-AHDF is characterized by the persistence of severe symptoms even when all possible pharmacological and surgical options have been exhausted. These patients are often treated with methods that allow extracorporeal UF - slow continuous ultrafiltration (SCUF) and continuous renal replacement therapy (CRRT) - which have to be performed in hospital facilities. Peritoneal ultrafiltration (PUF) can be considered a treatment option in patients with TR-AHDF when, despite the fact that all treatment options have been used, patients meet the following criteria: • stage D decompensated heart failure (ACC/AHA classification); • INTERMACS level 4 decompensated heart failure; • INTERMACS frequent flyer profile; • chronic renal failure (estimated glomerular filtration rate <50 ml/min per 1.73 m2: KDOQI classification stage 3 chronic kidney disease); • no obvious contraindications to peritoneal UF. PUF treatment modes are derived from the treatment regimens proposed by various authors to obtain systemic UF in patients with severe decompensated heart failure, using manual and automated incremental peritoneal dialysis involving various glucose concentrations in addition to the single icodextrin exchange. These guidelines also identify a minimum set of tests and procedures for the follow-up phase, to be supplemented, according to the center's resources and policy, with other tests that are less routine or more complex also from a logistic/organizational standpoint, emphasizing the need for the patient's clinical and treatment program to involve both the nephrologist and the cardiologist. The pathophysiological aspects of a deterioration in kidney function in patients with decompensated heart failure are also considered, and the results of PUF in patients with decompensated heart failure reported in the various case series are reviewed.
authors.affiliation: Department of Nephrology and Dialysis, San G. Bosco Hospital, Torino - Italy.
authors.forename: Gian Maria
authors.initials: GM
authors.lastname: Iadarola
authors.forename: Paola
authors.initials: P
authors.lastname: Lusardi
authors.forename: Vincenzo
authors.initials: V
authors.lastname: La Milia
authors.forename: Gianpaolo
authors.initials: G
authors.lastname: Amici
authors.forename: Stefano
authors.initials: S
authors.lastname: Santarelli
authors.forename: Giovambattista
authors.initials: G
authors.lastname: Virga
authors.forename: Carlo
authors.initials: C
authors.lastname: Basile
authors.forename: Silvio
authors.initials: S
authors.lastname: Bertoli
authors.forename: Renzo
authors.initials: R
authors.lastname: Bonofiglio
authors.forename: Goffredo
authors.initials: G
authors.lastname: Del Rosso
authors.forename: Mariano
authors.initials: M
authors.lastname: Feriani
authors.forename: Emilio
authors.initials: E
authors.lastname: Galli
authors.forename: Maurizio
authors.initials: M
authors.lastname: Gallieni
authors.forename: Giovanni
authors.initials: G
authors.lastname: Gambaro
authors.forename: Massimo
authors.initials: M
authors.lastname: Sandrini
authors.forename: Sergio
authors.initials: S
authors.lastname: Sisca
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cancarini
mesh_terms: D004232:Diuretics / Q000627:therapeutic use; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood / Q000145:classification / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D017583:Hemodiafiltration / Q000379:methods / Q000592:standards*; D006801:Humans; D020097:Natriuretic Peptide, Brain / Q000097:blood / Q000378:metabolism; D018579:Patient Selection; D010446:Peptide Fragments / Q000097:blood; D051437:Renal Insufficiency / Q000145:classification / Q000150:complications / Q000503:physiopathology / Q000628:therapy
chemical_list: D004232:Diuretics; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain