Peritoneal dialysis versus hemodialysis in end-stage kidney disease patients with congestive heart failure: A comparative review

Congestive heart failure (CHF) is a major cause of morbidity and mortality in patients with end-stage kidney disease (ESKD), where fluid overload often necessitates kidney replacement therapy. While both hemodialysis (HD) and peritoneal dialysis (PD) are viable options, PD has been suggested to offer hemodynamic advantages due to its gradual ultrafiltration process. This review examines the comparative effects of PD and HD in ESKD patients with CHF undergoing maintenance dialysis, focusing on hospitalization rates, cardiac function, survival outcomes, and volume management. Several studies suggest that PD is associated with reduced hospitalization rates, particularly in diuretic-resistant CHF patients, and improved left ventricular ejection fraction (LVEF), especially in those with heart failure with reduced ejection fraction (HFrEF). Additionally, PD’s continuous ultrafiltration may lower the risk of intradialytic hypotension (IDH) compared to HD. However, survival outcomes remain inconsistent, with some studies reporting higher mortality in PD patients, likely due to selection bias, as PD is often used in hemodynamically unstable CHF patients. Despite these findings, there is no definitive consensus on whether PD offers a survival advantage over HD in CHF patients. Given the limitations of existing studies, further large-scale, prospective research is required to determine the optimal dialysis modality for CHF patients with ESKD and to clarify its impact on long-term clinical outcomes.