Refractory Heart Failure Treated with Peritoneal Dialysis: A Single-Center Experience with Eleven Patients

IntroductionRefractory heart failure, particularly when associated with chronic kidney disease, poses a major therapeutic challenge. In this context, peritoneal dialysis offers a treatment option that allows for gradual and continuous ultrafiltration, which may improve congestion management and reduce hospitalizations related to episodes of cardiac decompensation.ObjectiveTo report the Carcassonne Hospital Center’s experience with the use of peritoneal dialysis for refractory heart failure and to describe the stepwise treatment strategy developed at our center.MethodsWe conducted a retrospective, descriptive, single-center study of 11 patients with refractory heart failure associated with chronic kidney disease who were treated with peritoneal dialysis between September 2021 and September 2024.ResultsThe mean age of the patients was 77 years. All patients had advanced heart failure (NYHA III–IV) associated with stage 4 chronic kidney disease. During a mean follow-up of 15 months, an improvement in congestive symptoms and/or NYHA functional status was observed in nine patients. At the end of the follow-up period, the glomerular filtration rate (GFR), which was initially 20 to 25 mL/min/1.73 m², ranged from 10 to 20 mL/min/1.73 m² in the majority of patients; two patients reached 8 mL/min/1.73 m² and required an increase to four daily exchanges. Urine output remained preserved in 10 patients. Two patients were hospitalized for cardiac decompensation. Seven patients died, although their deaths were not directly attributable to peritoneal dialysis.ConclusionPeritoneal dialysis is a viable treatment option for carefully selected patients with refractory heart failure associated with advanced chronic kidney disease. Our experience highlights the feasibility of this approach and the value of multidisciplinary care based on gradual adjustment of the treatment strategy.