TREATING FLUID OVERLOAD WITH FLUID; ROLE OF PERITONEAL DIALYSIS IN MANAGEMENT OF HEART FAILURE



Amir Kazory, M.D., University of Florida, Gainesville, Florida, USA

Heart failure (HF) remains the most common reason for hospital admission in older patients resulting in significant burden on healthcare expenditure. The currently available therapeutic modalities for HF do not seem yet to be producing optimal results. Peritoneal dialysis (PD) represents a home-based therapeutic modality in which the gentle removal of the excess fluid (and sodium) takes place in the peritoneal cavity, hence potentially avoiding the renal adverse effects of high dose diuretics while providing continuous, predictable, and progressive decongestion. Improvement in left ventricular ejection fraction and providing a better quality of life through sustained alleviation of congestive symptoms are among proposed benefits of PD in patients with HF. Several studies of PD therapy for HF, although with small number of patients and short follow up periods, initially reported encouraging results. The findings of more recent studies that have included higher number of patients support the results of the initial reports, especially with regards to reduction in the re-hospitalization rate as well as the positive impact on left ventricular function. These findings are not only important from the standpoint of quality of life for these patients who remain free from hospitalization, but they are also of particular financial interest due to the fact that the majority of the cost of the care for HF patients is related to utilization of inpatient resources. In conclusion, based on the currently available data, PD therapy could represent a therapeutic option for patients in whom conventional and less-invasive management strategies have not been successful.