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Front. Physiol. | doi: 10.3389/fphys.2019.00310

Peritoneal ultrafiltration in the long-term treatment of chronic heart failure refractory to pharmacological therapy.

 EWA WOJTASZEK1, AGNIESZKA GRZEJSZCZAK1, STANISLAW NIEMCZYK1,  JOLANTA MALYSZKO1 and  JOANNA MATUSZKIEWICZ-ROWINSKA1*
  • 1Medical University of Warsaw, Poland

Abstract
Introduction. Despite continuous improvement in the treatment, congestive heart failure (CHF) is a growing health problem and a major cause of mortality and morbidity in the world. There is some positive experience with the removal of the fluid excess via peritoneum in those patients, regardless of their renal function. The aim of this study was to assess the efficacy of peritoneal ultrafiltration (PUF) with a single overnight exchange in the long-term treatment of refractory CHF.

Methods. The study included patients with CHF resistant to maximal tolerable pharmacological therapy, who had experienced at least 3 hospitalizations due to CHF during the preceding year and were disqualified from heart transplantation. All of them were treated with single overnight 7.5% icodextrin exchange.

Results. There were 15 patients (13 men), aged 72±9 years, with Charlson Comorbidity Index (CCI) 9±1.2, NYHA class IV (11 patients) or III (4 patients), and eGFR 32±11 m/min. They were followed up for 24±8 months (range 12 -43, median 26 months). During the first year, all patients improved their NYHA functional class from 3.7±0.5 to 2.6±0.5; P=0.0005, with stable (34.3±12.4, and 35.6±16.5%, respectively) left ventricular ejection fraction (LVEF), and inferior vena cava (IVC) diameter decreased from 27.8±2.7 to 24.4±3.4 mm; P=0.09. Daily diuresis increased from 867±413 to 1221±680 ml; P=0.25, while the dose of furosemide could be reduced from 620±256 to 360±110 mg/d; P=0.0005, however the kidney function deteriorated, with e-GFR drop from 32±11 to 25.6±13 ml/min/1.73m2; P=0.01). CHF-related hospitalizations decreased from 8.9±2.8 days/month to 1.5±1.2 days/month (P=0.003). Mechanical peritoneal dialysis complications occurred in 5 patients and infectious complications in 4 (peritonitis rate 1 per 72 patient-month). Patient survival was 93% at 1 year and 73% at 2 year. Technique survival was 100%.

Conclusions. In patients with refractory CHF, PUF with single icodextrin overnight exchange appears to be a promising therapeutic option as an adjunct to pharmacological management of those who are not transplant candidates. It should be emphasized that the treatment can have a great impact on the quality of life and the total costs of treating these patients.

Keywords: congestive heart failure, cardiorenal syndrome, Peritoneal ultrafiltration, Icodextrin, Patient survival, CHF-related hospitalsations

Received: 22 Sep 2018; Accepted: 07 Mar 2019.

Edited by:

Janusz Witowski, Poznan University of Medical Sciences, Poland

Reviewed by:

Anabela S. Rodrigues, Abel Salazar Institute of Biomedical Sciences, University of Porto, Portugal
Sitaramesh Emani, Ohio State University Hospital, United States  

Copyright: © 2019 WOJTASZEK, GRZEJSZCZAK, NIEMCZYK, MALYSZKO and MATUSZKIEWICZ-ROWINSKA. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Prof. JOANNA MATUSZKIEWICZ-ROWINSKA, Medical University of Warsaw, Warsaw, Poland, jrowinska@gmail.com