Continuous Ambulatory Peritoneal Dialysis as Treatment of Severe Congestive Heart Failure in the Face of Chronic Renal Failure

\s=b\ Eight patients with severe heart failure and renal insufficiency whose conditions were refractory to diuretics were treated by continuous ambulatory peritoneal dialysis. Seven of the eight patients died. Although the patients no longer had uncontrolled congestive heart failure, hospitalization rates failed to improve due to dialysis complications and underlying heart disease. The one long-term survivor was being treated with diuretics alone after peritoneal dialysis was used to control heart failure. Although survival was short after initiation of dialysis (median survival, 225 days), this therapy may merit further study in patients less ill. (Arch Intern Med 1986;146:1533-1535) many patients congestive heart failure becomes re* fractory to standard medical therapy. This patient pop¬ ulation may reach a point at which further medical man¬ agement compromises cardiac output often before fluid overload is controlled by therapy. In these instances a patient with underlying renal disease may suffer a deterio¬ ration in renal function. In the presence of congestive heart failure and inadequate renal perfusion, peritoneal dialysis affords a means of effecting fluid removal and stabilizing the vascular compartment.1"10 Continuous ambulatory peritoneal dialysis (CAPD) and intermittent peritoneal dialysis offer unique advantages. First, the techniques are simple. Second, fluid can be removed continuously, thus avoiding the thirst that accom¬ panies rapid fluid removal, and a regular schedule for removal of fluid weight can be utilized in patients who develop pulmonary edema with small changes in the intravascular volume. Third, the diet can be less restricted, particularly as to sodium and protein content. Fourth, CAPD would offer additional treatment of renal failure and electrolyte imbalance. The present study was designed to evaluate whether CAPD would be therapeutic in patients with severe con¬ gestive heart failure and compromised renal function. Our rationale was that this therapy would maintain improved fluid balance, thus decreasing the number of hospitalizations and perhaps rendering patients' conditions again responsive to diuretics.