The role of peritoneal dialysis in the treatment of refractory heart failure.

Heart failure (HF) refractory to conventional therapy is a major and increasing public health and financial problem. Refractory HF is associated with hypervolaemia due to sodium and fluid retention, and azotaemia due to renal hypoperfusion. There is extreme renal salt and water retention and marked secondary hyperaldosteronism. In this state, the kidneys are relatively resistant to diuretic therapy, and the use of very high doses of oral or parenteral diuretics only worsens the renal hypoperfusion, making the patient more azotaemic. A logical treatment for this 'cardiorenal syndrome' is the use of dialysis, which is efficient in treating both the hypervolaemia and azotaemia of refractory HF. Peritoneal dialysis (PD), haemodialysis or continuous veno-venous haemofiltration can and have been used, but the simplest long-term treatment is PD. We present several case reports of the successful use of PD in refractory heart failure. In our opinion, chronic PD is a highly effective mode of treatment for refractory HF, and should be more widely used in this condition.