The impact of peritoneal dialysis upon quality of life and mortality of patients with end-stage congestive heart failure.

Background: Aged patients affected by congestive heart failure refractory to pharmacologic therapy, coupled with severe comorbidities that preclude heart transplantation have a gloomy prognosis. Use of automated peritoneal dialysis resulted in a significantly improved quality of life and survival.

Methods: Twenty patients (mean age: 65.7 +/- 7.7 years) with severe congestive heart failure (Class IV-NYHA) and a high Charlson comorbidity index (7.8 +/- 1.8) were treated by means of automated peritoneal dialysis (3 sessions/week, 8 h each). The period of follow-up ranged between 7 and 35 months (19.8 +/- 7.4 months).

Results: After 1 year of follow-up, all patients showed functional (Class I-NYHA) and hemodynamic improvement: left cardiac work index increased from 2.33 +/- 0.69 to 2.59 +/- 0.47 kg/min/m(2) (p < 0.01); systolic times ratio was significantly reduced (from 61.14 +/- 12.57 to 39.18 +/- 13.44%, p < 0.01); and the thoracic fluid contents was substantially reduced (from 0.04 +/- 0.005 to 0.003 +/- 0.0001 Omega). A marked drop of hospitalization days was observed.

Conclusions: Automated peritoneal dialysis appears as a promising tool for treating patients suffering from refractory, end stage congestive heart failure. Improvement of cardiac function may result from clearing the blood from middle molecular weight myocardial depressant substances, including atrial natriuretic peptide. Results of this investigation are a call for a prospective multicenter study in order to confirm these promising observations.