Therapeutics Advances
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Nephrol. Jul 6, 2017; 6(4): 168-175
Published online Jul 6, 2017. doi: 10.5527/wjn.v6.i4.168
Fluid overload as a major target in management of cardiorenal syndrome: Implications for the practice of peritoneal dialysis
Amir Kazory
Amir Kazory, Division of Nephrology, Hypertension and Renal Transplantation, College of Medicine, University of Florida, Gainesville, FL 32610-0224, United States
Author contributions: Kazory A finished this manuscript solely.
Conflict-of-interest statement: The author has no potential conflict of interest to declare with respect to this paper.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Amir Kazory, MD, FASN, Division of Nephrology, Hypertension and Renal Transplantation, College of Medicine, University of Florida, 1600 SW Archer Road, Gainesville, FL 32610-0224, United States. kazory@medicine.ufl.edu
Telephone: +1-352-2738822 Fax: +1-352-3923581
Received: January 10, 2017
Peer-review started: January 16, 2017
First decision: February 20, 2017
Revised: February 23, 2017
Accepted: May 18, 2017
Article in press: May 20, 2017
Published online: July 6, 2017
Processing time: 170 Days and 20 Hours
Abstract

Congestion is an integral component of cardiorenal syndrome and portends an adverse impact on the outcomes. Recent studies suggest that congestion has the ability of modulating the interactions between the kidney and the heart in this setting. Peritoneal dialysis (PD) is a home-based therapeutic modality that is not only offered to patients with end-stage renal disease to provide solute clearance and ultrafiltration, but it has also been used in patients with refractory heart failure and fluid overload to help optimize volume status. Several uncontrolled studies and case series have so far evaluated the role of PD in management of hypervolemia for patients with heart failure. They have generally reported favorable results in this setting. However, the data on the outcomes of patients with end-stage renal disease and concomitant heart failure is mixed, and the proposed theoretical advantages of PD might not translate into improved clinical endpoints. Congestion is prevalent in this patient population and has a significant effect on their survival. As studies suggest that a significant subset of patients with end-stage renal disease who receive PD therapy are hypervolemic, suboptimal management of congestion could at least in part explain these conflicting results. PD is a highly flexible therapeutic modality and the choice of techniques, regimens, and solutions can affect its ability for optimization of fluid status. This article provides an overview of the currently available data on the role and clinical relevance of congestion in patients with cardiorenal syndrome and reviews potential options to enhance decongestion in these patients.

Keywords: Heart failure; Peritoneal dialysis; Congestion; Cardiorenal syndrome

Core tip: Congestion has been recognized as a dynamic state capable of modulating the interactions between the heart and the kidney in patients with cardiorenal syndrome. Optimization of volume status could significantly affect the outcomes of patients treated with peritoneal dialysis (PD) patients for end-stage renal disease and pre-existing heart failure. Since PD is a highly modifiable therapeutic modality, it is conceivable that a regimen customized to the clinical characteristics and needs of the patients could improve their outcomes through efficient decongestion and optimization of volume status.