#2920 Peritoneal dialysis for volume overload in heart failure: a single-center experience
Authors: Carnevale Andreia , Pepe Bruno , Domingos Diogo , Calça Rita , Matias Patrícia , Branco Patrícia , Gaspar Augusta 
Published: May 2024

Abstract

Background and Aims
While diuretics are considered the first-line therapy to control volume overload in heart failure (HF), diuretic resistance can develop, limiting the effectiveness of pharmacological therapy. Peritoneal dialysis (PD) is a kidney replacement therapy usually implemented in advanced or acute kidney failure. However, it can be used to allow ultrafiltration and volume control in refractory cases, either due to kidney or refractory congestive HF. The aim of this study was to describe a single-center experience and study the clinical outcomes of a population of patients with HF that initiated PD for volume control.

Method
Retrospective single-center study with patients who started PD for volume control between January 1st 2011 and December 31st 2023, with a follow-up of 12 months after start of dialysis or until technique dropout. Demographic and clinical information regarding comorbidities, characteristics of HF, therapeutic management and markers of volume overload (NT-proBNP and CA-125) was collected. The impact on both therapy management and overload markers after six months of PD was also studied.

Results
Nineteen patients were included in this study, 78.9% of male gender and with a mean age of 63.4 ± 17.2 years. Comorbidities included diabetes in 63.2%, hypertension in 73.7%, coronary arterial disease in 57.8% and peripheral arterial disease in 26.3%. The NYHA (New York Heart Association) class was III or IV in 12 patients (63.1%), with an average left ventricle ejection fraction of 40% ± 14.1, due to ischemic and/or valvular causes in 73.7%. PD vintage was 12 months (IQR 0), with a median glomerular filtration rate (GFR) at the start of peritoneal dialysis of 15 ml/min (IQR 11) while nine patients (47.3%) started with a GFR above 15 mL/min. There was an increase in the number of patients being treated with renin-angiotensin-aldosterone system inhibitors, sodium-glucose co-transporter-2 inhibitors and mineralocorticoids receptor antagonists at six months. Outcomes reported low numbers of major adverse cardiac events, episodes of peritonitis and infection of the peritoneal catheter outer orifice. The number of hospitalizations due to HF was also significantly lower after start of PD (p-value = 0.044). There was a decrease in serum NT-proBNP levels after six months of therapy (p-value = 0.571), with a statistically significant decrease in CA-125 (p-value &lt; 0.001). There was only one reported death during follow-up.

Conclusion
While PD has classically been viewed only as a kidney replacement therapy, it can also be considered a viable option for refractory volume overload associated with HF. Results suggest an optimization of HF guideline-directed therapy and a decreased number of hospitalizations, with consequent better management of the disease and improved quality of life. There was no negative impact associated with the implementation of PD in this population, with the decrease in CA-125 serum levels also suggesting an overall decrease of volume overload with this technique.