Amir Kazory1, Abhilash Koratala2, Claudio Ronco3,4. 1. Division of Nephrology, Hypertension, and Renal Transplantation, University of Florida, Gainesville, Florida, USA, amir.kazory@medicine.ufl.edu. 2. Division of Nephrology, Hypertension, and Renal Transplantation, University of Florida, Gainesville, Florida, USA. 3. Department of Nephrology, San Bortolo Hospital, Vicenza, Italy. 4. International Renal Research Institute of Vicenza (IRRIV), San Bortolo Hospital, Vicenza, Italy.
Abstract
BACKGROUND: Peritoneal dialysis (PD) has emerged as a mechanistically relevant therapeutic option for patients with heart failure (HF), volume overload, and varying degrees of renal dysfunction (i.e., chronic cardiorenal syndrome). Congestion has been identified as a potent ominous prognostic factor in this patient population, outperforming a number of established risk factors. As such, excess fluid removal is recognized as a relevant therapeutic target in this setting. METHODS: Accumulating evidence points to the importance of sodium removal as part of any decongestive strategy because extraction of sodium-free water has little or no impact on the outcomes of these patients. Hence, optimization of sodium removal by PD should be the primary focus in the setting of HF and cardiorenal syndrome, especially if PD is started when the patient still has adequate residual renal function for clearance of waste products. RESULTS: Herein, we provide an overview of approaches that can tailor PD treatment to the patients' characteristics and clinical needs (e.g., choice of PD modality) to fully exploit its decongestive properties. Other methods that could prove helpful in the future will also be briefly discussed. CONCLUSION: While these strategies could help with efficient sodium extraction and volume optimization, future studies are needed to evaluate their impact on the outcomes of this specific patient population.
BACKGROUND: Peritoneal dialysis (PD) has emerged as a mechanistically relevant therapeutic option for patients with heart failure (HF), volume overload, and varying degrees of renal dysfunction (i.e., chronic cardiorenal syndrome). Congestion has been identified as a potent ominous prognostic factor in this patient population, outperforming a number of established risk factors. As such, excess fluid removal is recognized as a relevant therapeutic target in this setting. METHODS: Accumulating evidence points to the importance of sodium removal as part of any decongestive strategy because extraction of sodium-free water has little or no impact on the outcomes of these patients. Hence, optimization of sodium removal by PD should be the primary focus in the setting of HF and cardiorenal syndrome, especially if PD is started when the patient still has adequate residual renal function for clearance of waste products. RESULTS: Herein, we provide an overview of approaches that can tailor PD treatment to the patients' characteristics and clinical needs (e.g., choice of PD modality) to fully exploit its decongestive properties. Other methods that could prove helpful in the future will also be briefly discussed. CONCLUSION: While these strategies could help with efficient sodium extraction and volume optimization, future studies are needed to evaluate their impact on the outcomes of this specific patient population.
Authors: Bourne L Auguste; Arnav Agarwal; Ali Z Ibrahim; Michael Y Girsberger; Zita Abreu; Rory F McQuillan; Joanne M Bargman Journal: Can J Kidney Health Dis Date: 2020-12-08