Can we treat fluid overload with fluid? Role of peritoneal dialysis in management of heart failure

摘要

Heart failure (HF) is the most common reason for hospital admission in patients older than 65, with a total burden on healthcare of US$35-60 billion per year in the USA alone.1 In spite of a shifting paradigm in the treatment of HF over the past two decades, the currently available therapeutic modalities do not yet seem to be producing optimal results. In a study on >50 000 patients in the Acute Decompensated Heart Failure National Registry (ADHERE) database, nearly half of the patients admitted for exacerbation of HF lost <2.3 kg (33%), or even gained weight (16%) during the course of hospitalization.2 It is not then surprising that the 30-day readmission rate still remains as high as 27%, the highest among all medical conditions necessitating hospitalization.3 This lack of desired efficacy can be complicated further by potential adverse effects of the current therapies on renal function, leading to an increase in morbidity and healthcare expenditure.