Peritoneal Ultrafiltration in Cardio Renal Syndrome.

Inclusion Criteria:

• Age ≥18 yrs

• Left ventricular ejection fraction ≤60%

• NYHA Classification of III-IV despite guidelines directed medical therapy

• Right ventricular failure due to after load mismatch, addressed by the presence oftricuspid calve regurgitation (≥ moderate) and by the disproportioned increase ofthe right atrial pressure (RAP) versus the capillary wedge pressure (CWP) with aratio ≥0.65, detected with right heart catheterization performed after stablemedical therapy according to international guidelines and comprehensive of loopdiuretic (equivalent to furosemide oral dose till 2.0 mg/kg/day), coupled withurinary sodium excretion ≤ mEq/L, confirmatory of loop diuretic resistance.

• Cava vein enlargement (inner diameter, detected with focused echocardiography,between 1,5 and 2,5 cm, with respiratory collapse <50% or absent due tointravascular fluid overload)

• Decreased kidney function addressed by the measurement of glomerular filtration rate (GFR) urea clearance + creatinine clearance/2 (>15 ml/min/1,73 m2)

• NT pro-BNP plasma concentration > 1000 pg/ml or BNP plasma concentration > 250 pg/ml

• at least one episode of pulmonary or systemic congestion requiring high-doseintravenous diuretics (or diuretic combinations) in the 6 months befor the studyenrollment

• An appropriate PUF technique candidate.

• Signed informed consent

Exclusion Criteria:

• Recipients of heart transplantation

• Presence of a mechanical circulatory support device;

• Hypertrophic obstructive cardiomyopathy;

• Uncontrolled hypertension with systolic blood pressure ≥ 160 mmHg

• Severe valvular stenosis;

• Restrictive cardiomyopathy;

• Acute coronary syndrome ≤ 6 months before;

• Active myocarditis

• Cardiosurgical or Endo-radiological heart procedures ≤ 6 months before

• Cardiac resynchronization therapy (CRT) implantation or upgrading of pacemaker (PM)or implantable cardioverter defibrillator (ICD) to CRT ≤ 6 months before;

• Patient with end-stage renal disease, GFR urea clearance + creatinine clearance/2 (<15 ml/min/1,73 m2 GFR)

• Any major organ transplant (liver, lung, kidney)

• Lung embolism ≤ 6 months before;

• Fibrotic lung disease;

• Liver Cirrhosis;

• Absolute contraindication to peritoneal catheter implantation;

• Logistical and or organizational contra-indication to treatment

• Active malignancy;

• Female patients who are pregnant or breast-feeding or who wish to become pregnantduring the period of the clinical trial and for three months later

• Female patients of childbearing age who do not use adequate contracteption.

• Unwilling and unable to give informed consent;

• Enrolment in another clinical trial involving medical or device based interventions.

• Hypersensibility to IMP components.

• Evidence of any condition that, according to the investigators' judgment, couldexpose the subject to undue risk and/or prevent the subject from participating inthe study procedures and/or potentially afftecting the study quality data.