Dialysis Therapy for Volume Overload: A Feasible Option to Reduce Heart Failure Hospitalizations in Advanced Heart Failure

Background: Advanced heart failure (HF) carries a high rate of recurrent HF hospitalizations and a very high mortality rate. Mechanical devices and heart transplantation are limited to a select few. Dialysis may be a good alternative for advanced HF patients with volume overload despite maximal pharmacological therapy. We assessed the net clinical outcome of peritoneal dialysis or hemodialysis in patients with advanced HF.

Methods: We analyzed all advanced HF patients that were referred for dialysis due to volume overload in our institution. Patients were followed for complications, HF hospitalizations and survival.

Results: A total of 35 patients were assessed. 10 patients (29%) underwent peritoneal dialysis and 25 (71%) hemodialysis. 71% were male; median (interquartile range) age 78 (74-86) years. Estimated glomerular filtration rate was 32 (20-50) mL/min per 1.73 m2. NYHA functional capacity was III. The majority of patients (90%)? were treated with intravenous diuretics in a day care prior to dialysis. Median follow-up time was 719 days (658-780). One-year mortality rate was 8/35 (23%) and overall mortality rate was 12/35 (35%), approximately the estimated mortality rate in this advanced HF cohort. Three patients (9%) died during the first year due to line or peritoneal dialysis related sepsis and 5 died (14%) during all follow-up. There was a marked reduction in HF hospitalizations due to the dialysis. The median number of HF hospitalizations was significantly reduced during the year after dialysis compared to the year prior to dialysis (0.0 (0.0-1.0) vs. 2.0 (0.0-3.0), P<0.001; Figure 1).

Conclusions: Dialysis appears reasonably safe and significantly reduced HF hospitalization in advanced HF patients. Dialysis could be a good alternative for advanced HF patients with intractable volume overload.