Difficult cases in heart failure: Role of continuous ambulatory peritoneal dialysis in refractory heart failure.

Continuous ambulatory peritoneal dialysis (CAPD) offers a new modality for use in the treatment of refractory congestive heart failure (CHF). Although the use of peritoneal dialysis to treat refractory heart failure is not new, improved understanding of the physiology and technique of this system has allowed its use over prolonged periods of time. The application of continuous peritoneal dialysis to the cardiac patient changes its scope considerably. When combined with current medical treatment, it removes fluid volume effectively and safely providing the best possibility for prolonged medical improvement. Continuous ambulatory peritoneal dialysis should be considered in patients with biventricular failure who have associated comorbidities like pulmonary hypertension and progressive renal insufficiency. We report the management of two such patients with NYHA Class IV heart failure who had become unresponsive to maximum pharmacological management and developed prerenal dialysis and during the 6 month follow up remained on dialysis without developing any significant complications and improved to NYHA class I. (c)1999 by CHF, Inc.