Questions About PD
PD can be an excellent option for patients with CHF. Significant UF can be achieved, and because the fluid removal is more gentle than with HD, PD can be less hemodynamically destabilizing in patients with cardiac disease/low ejection fraction. PD utilization varies widely by center and region, but patients and practitioners should be encouraged to consider PD in this setting. If the patient has reasonable clearance, one can even consider starting with incremental PD (fewer than 4 exchanges) with a focus on optimizing UF. This may include the use of Icodextrin for the long dwell.