Abstract: Chronic heart failure is a common clinical cardiovascular disease and refractory heart failure (RHF) is the final stage of cardiac insuffciency. Renal sodium retention remains a key event in the pathogenesis of the disease progression and episodes of severe cardiac decompensation. Peritoneal dialysis (PD) is a homebased therapeutic modality then can be used in patients with RHF. Studies of PD in heart failure patients with chronic kidney disease and refractory fluid overload have shown this modality is associated with weight loss, improved quality of life, and reduction in heart failure hospitalizations and increase in left ventricular ejection fraction (LVEF). We aim to review the contemporary evidence of PD in patients with RHF across the spectrum of indications, optimal timing of PD intervention, techniques, and vasoactive medicine therapy.

Key words: peritoneal dialysis, cardiorenal syndrome, refractory heart failure