title: Peritoneal ultrafiltration in end-stage chronic heart failure.
abstract: BACKGROUND
  Cardiorenal syndrome type 2 (CRS-2) is common in end-stage chronic heart failure (CHF). Peritoneal ultrafiltration (pUF) may entail clinical functional improvement and a reduction in hospitalizations.
  
  
  METHODS
  Thirty-nine consecutive end-stage CHF patients with stable CRS-2 were initiated on ambulatory pUF after interdisciplinary cardiological/nephrological evaluation and prospectively followed for 1 year. All-cause hospitalization was the primary end point. Secondary end points included mortality, treatment alteration and change in weight, NYHA functional class or quality of life (QoL). Outcomes were compared both within the pUF cohort (365 prior to initiation) and with 39 matched CHF patients receiving standard medical treatment.
  
  
  RESULTS
  Compared with pretreatment, there was a trend to a reduction in 1-year hospitalization days in the pUF group (P = 0.07). One-year mortality was 33% in the pUF group and 23% in the matched control cohort. pUF was stopped in eight patients (18%) due to recurrent peritonitis (n = 3), insufficient ultrafiltration (n = 3) or cardiac recompensation (n = 1). Compared with standard medical treatment, pUF significantly improved volume overload (P < 0.05), NYHA functional class (P < 0.001) and mental health (P < 0.05). Moreover, hospitalization days for all causes as well as cardiovascular hospitalization days were significantly reduced during the interim periods in the pUF group (P < 0.05 and P < 0.001, respectively).
  
  
  CONCLUSIONS
  pUF is effective in improving the clinical condition of end-stage CHF patients suffering from CRS-2. Randomized controlled trials are needed to clarify the effects of pUF on hospitalization and mortality in these patients.
authors: Department of Cardiology , University Hospital Heidelberg , Heidelberg , Germany.
authors: Hanna
authors: H
authors: Fröhlich
authors: Department of Cardiology , University Hospital Heidelberg , Heidelberg , Germany.
authors: Hugo A
authors: HA
authors: Katus
authors: Department of Cardiology , University Hospital Heidelberg , Heidelberg , Germany.
authors: Tobias
authors: T
authors: Täger
authors: Department of Cardiology , University Hospital Heidelberg , Heidelberg , Germany.
authors: Nicole
authors: N
authors: Lossnitzer
authors: Department of Nephrology , University Hospital Heidelberg , Heidelberg , Germany.
authors: Leonie
authors: L
authors: Grossekettler
authors: Department of Cardiology , University Hospital Heidelberg , Heidelberg , Germany.
authors: Lars
authors: L
authors: Kihm
authors: Department of Nephrology , University Hospital Heidelberg , Heidelberg , Germany.
authors: Martin
authors: M
authors: Zeier
authors: Heart and Vascular Centre Bad Bevensen , Bad Bevensen , Germany.
authors: Andrew
authors: A
authors: Remppis
authors: Department of Nephrology , University Hospital Heidelberg , Heidelberg , Germany.
authors: Lutz
authors: L
authors: Frankenstein
authors: Department of Nephrology , University Hospital Heidelberg , Heidelberg , Germany.
authors: Vedat
authors: V
authors: Schwenger
keywords: cardiorenal syndrome; chronic heart failure; haemodialysis; hospitalization; peritoneal ultrafiltration