Mr Kye Manefield1
1Alfred Health, Melbourne, Australia
End-stage kidney disease is a common complication of Cardiorenal Syndrome. Dialysis management in this setting is challenging due to haemodynamic instability which limits conventional dialysis and ultrafiltration delivery. Although patient complexity, instrumentation (particularly Ventricular Assist Devices [VADs]), and accompanying transperitoneal drivelines present a barrier to uptake, we describe the successful application of peritoneal dialysis (PD) in this context.
In 2018, a 62-year-old male with end-stage non- obstructive dilated hypertrophic cardiomyopathy underwent a VAD implantation. Renal function deteriorated in the setting of post-operative decompensated heart failure, necessitating continuous haemofiltration in ICU, followed by transition to conventional intermittent high-flux haemodialysis (HDx). The patient failed to thrive on HDx, suffering from ongoing lethargy alongside repeated symptomatic cardiac decompensation (mean arterial pressure (MAP) < a target of 58mmHg) necessitating urgent clinical reviews. After considering alternatives, a Tenckhoff catheter was placed percutaneously and the patient was commenced on PD.
Several key benefits were quickly manifest from this change of modality. Firstly, PD allowed for a supportive care giver model to be used in which the patient’s wife was trained in PD exchanges- allowing the patient the option of dialysing at home. Secondly, PD supported cardiac function, reliably achieving MAP between 70-94mmHg. Following improvements in fluid state, energy levels, nutrition and global function, the patient progressed to candidacy for combined heart-kidney transplantation.
This case study illustrates the potential benefits of PD in patients at risk of cardiac instability, supporting its role as a viable treatment option for the complex patient with Cardiorenal Syndrome.
Biographies to come