Abstract: TH-PO0921
Sustained Volume Control and Clinical Recovery: Peritoneal Dialysis in ESRD with Refractory Heart Failure
Session Information
- Home Dialysis: Utilization Patterns, Complications, and Quality-of-Life Outcomes
October 22, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 802 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- Ben Musa, Ruwaida, University of Missouri, Columbia, Missouri, United States
- Khanna, Ramesh, University of Missouri, Columbia, Missouri, United States
Introduction
Congestive heart failure (CHF) in patients with end-stage renal disease (ESRD) is associated with recurrent hospitalizations, diuretic resistance, and poor quality of life. Management is particularly challenging in cardiorenal syndrome, where conventional therapies often fail to achieve adequate volume control. Peritoneal dialysis (PD), especially CAPD, provides continuous ultrafiltration and may offer a more physiologic and effective approach to sustained volume control in this population.
Case Description
We report the case of an 82-year-old man with advanced ischemic cardiomyopathy (left ventricular ejection fraction 15–20%), status post coronary artery bypass grafting and cardiac resynchronization therapy. Despite optimized medical therapy, he experienced recurrent hospitalizations for decompensated heart failure, complicated by diuretic resistance and progressive cardiorenal syndrome leading to sever AKI and CKD.
During hospitalization in June 2025 for acute hypoxic respiratory failure and pulmonary edema, an urgent-start PD catheter was placed and PD was initiated. Following initiation and subsequent intensification of PD, the patient demonstrated marked and sustained clinical improvement. He achieved effective volume control with approximately 9 kg fluid weight loss, complete resolution of peripheral edema with marked improvement in dyspnea. Diuretic requirements decreased substantially, and functional status improved to NYHA class II, allowing independent daily activities and exercise. These benefits were maintained over prolonged follow-up without further heart failure hospitalizations. Improvement appeared primarily attributed to continuous volume removal rather than cardiac recovery, although modest LVEF improvement may have contributed.
Discussion
Peritoneal dialysis represents a highly effective and underutilized adjunctive therapy for refractory heart failure in patients with ESRD. By providing continuous and gentle volume control, PD can significantly reduce symptom burden, improve functional capacity, and enhance quality of life—even in the absence of meaningful cardiac recovery. This case supports the broader consideration of PD as a strategic therapeutic modality in advanced cardiorenal syndrome. Emerging clinical experience further suggests that this therapeutic approach may benefit patients with refractory heart failure even in the absence of ESRD.