Recomendaciones para diálisis peritoneal en insuficiencia cardiaca congestiva: prescripción y manejo multidisciplinario

Background: Refractory congestive heart failure (RCHF) is not only a cause of mortality in patients with cardiovascular disease, but the congestive symptoms also lead to morbidity, deterioration in quality of life, multiple hospitalizations, and increased healthcare costs. Conventional pharmacological therapies for managing congestion can be challenging or contraindicated in patients with RCHF and chronic kidney disease (CKD), especially in acute conditions or with cardiorenal syndrome. Peritoneal dialysis, with its various modalities, offers significant benefits for patients with refractory congestion; however, many multidisciplinary teams are unaware of specific aspects of peritoneal dialysis solutions and prescriptions. Purpose: To provide a narrative synthesis and multidisciplinary recommendations on peritoneal dialysis in patients with refractory congestive heart failure (RCHF). Methodology: A non-systematic literature review was conducted along with a multidisciplinary perspective to present a synthesis of current recommendations for personalized peritoneal dialysis prescription in congestive heart failure, with a patient-and family-centered approach. Results: The evidence extracted shows peritoneal dialysis as a therapeutic alternative for patients with refractory congestive heart failure (ICCR), allowing volume management, maintaining glomerular filtration rate compared to other therapies, reducing ventricular load and congestion, and improving functional class. There is variability in prescription practices, so a physiologically based DP prescription proposal is made. Through the current needs of the disease, personalized management is proposed with a multidisciplinary model for the management of the patient with ICCR from a patient and family-centered approach. Conclusions: Peritoneal dialysis is a viable and cost-effective therapeutic option in cases of RCHF with limited treatment alternatives. Its success depends on a multidisciplinary approach, effective communication, and clinical follow-up; thus, understanding the physiology of peritoneal dialysis and tailoring the therapy individually leads to better outcomes.