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Perit Dial Int 27(Supplement_3): 13- 2007
© 2007 International Society for Peritoneal Dialysis
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Cardiovascular Disease

Treatment of Severe Congestive Heart Failure with Icodextrin Ultrafiltration

S.S. Guest

Kaiser Permanente Medical Center, Santa Clara, California, USA

Objective: Congestive heart failure (CHF) affects millions of Americans and is the leading cause of hospitalization in adults over 65 years of age. Small case reports have described the use of icodextrin to induce ultrafiltration (UF) as a treatment of CHF in patients who are not at end-stage renal disease. This abstract reviews these published cases.

Methods: Literature search based on PubMed submissions using keywords icodextrin, ultrafiltration, congestive heart failure, cardiomyopathy, peritoneal dialysis. Contact was also made with Baxter Renal Division seeking additional cases.

Results: 27 patients with severe CHF treated with icodextrin were identified. Pretreatment ejection fractions ranged from <20% to 35%. Some patients were described as having "normal" glomerular filtration rate, the others were CKD stages 3 and 4. Single nocturnal exchanges of icodextrin were prescribed but in some cases 2 exchanges a day were used. The mean UF volume was 1046 mL/day. No hypotension was reported. Patients frequently admitted to the hospital prior to UF had reduction in hospitalizations. In those that documented ejection fraction the cardiac function was noted to improve with UF. All patients had improvement in their clinical status and New York Heart Association classification. Two of the 27 required additional peritoneal dialysis exchanges for increased UF. Only 1 report documented peritonitis rates: the rate was 1 episode per 100 patient-months. See poster presentation for summary of data.

Conclusions: Icodextrin-based UF has been successfully employed to control severe CHF refractory to medical management. The reduction in hospitalizations suggests that peritoneal UF with icodextrin can be cost-effective and lead to improvement in function and quality of life.






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