Long-term automated peritoneal dialysis in patients with refractory congestive heart failure.

Patients with severe congestive heart failure (CHF), mainly class IV on the New York Heart Association (NYHA) scale, became refractory to standard medical therapy. The factor that favored that evolution was renal insufficiency with inadequate renal perfusion. Our objectives in the present study were to make a preliminary assessment of the usefulness of automated peritoneal dialysis (APD) for the treatment of volume overload in those patients. Our study was carried out in the peritoneal dialysis unit of the clinical hospital of Pontificia Universidad Católica de Chile. We studied 3 non uremic patients with refractory CHF secondary to ischemic cardiomyopathy, severe secondary lung hypertension (> 70 mmHg), and associated moderate renal insufficiency. The patients (2 women and 1 man) ranged in age from 55 years to 68 years. A Tenckhoff double-cuff peritoneal catheter was placed in each patient, and peritoneal dialysis was carried out using the nightly intermittent peritoneal dialysis (NIPD) modality. The treatment used was appropriate to obtain a gradual removal of fluids: dialysate dextrose at 1.5% and 2.5%, 4-5 cycles, and total volume of 10-12 L per night. All three patients were able to remain at home, with no signs of hypervolemia. The frequency and length of hospitalizations decreased on average from 59 days pre-APD to 37 days post-APD. No hospitalizations for cardiac problems occurred, and the mean survival was 11 months (range: 6-22 months). This preliminary observation suggests that APD could be offered as an effective treatment for helping to remove fluids in patients with refractory CHF, reducing the number and length of hospitalizations, and improving quality of life.