In Italy, the congestive heart failure is the leading cause of hospitalization and despite advances in therapy, the long-term prognosis is poor. Congestive heart failure is associated with advanced varying degrees of chronic renal disease that identify the cardio-renal syndrome type 2. High-dose diuretic therapy often fail to solve the water overload that is frequently the cause of death. The resistance to diuretics aggravates the state of the patient's edema and consequently morbidity and mortality. In the acute stage, the extracorporeal ultrafiltration unable to repair over hydration but needs frequent access weekly or midweek at the dialysis center. In addition, the significant changes of the fluid overload induce the risk of intradialytic hypotension and consequent renal hypoperfusion can cause a gradual loss of kidney function. The ultrafiltration can also be obtained using a method similar to the peritoneal dialysis (peritoneal ultrafiltration -PUF) but with a limited daily commitment both manual and automated modalities because the indication is not the correction of end stage renal disease. PUF is a home treatment and is indicated for chronic congestive heart failure with refractory hypervolemia despite optimal sequential diuretic therapy. PUF clinical results for the treatment of chronic congestive heart failure have demonstrated effectiveness in improving the clinical condition with reduction of NYHA class and improvement of FE%, the reduction of days of hospitalization, in reducing mortality, improving quality patient's life. In addition, PUF ensures a constant and continuous ultrafiltration, similar to renal function and thus allows a constant hemodynamic stability and ensures the maintenance of diuresis and the residual renal function. Therefore PUF in patients with refractory heart failure seems to be a viable integration of cardiological therapy and the encouraging results lead to the search of a multidisciplinary collaboration between cardiologist and nephrologist to ensure the patient a simple and effective "home" management for the treatment of a pathology so serious.
Keywords: icodextrin; peritoneal ultrafiltration; refractory congestive heart failure.
Copyright by Società Italiana di Nefrologia SIN, Rome, Italy.