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 of tricuspid calve regurgitation (≥ moderate) and by the disproportioned increase of the right atrial pressure (RAP) versus the capillary wedge pressure (CWP) with a ratio ≥0.65, detected with right heart catheterization performed after stable medical therapy according to international guidelines and comprehensive of loop diuretic (equivalent to furosemide oral dose till 2.0 mg/kg/day), coupled with urinary 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 to intravascular 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-dose intravenous diuretics (or diuretic combinations) in the 6 months befor the study enrollment * 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 pregnant during 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, could expose the subject to undue risk and/or prevent the subject from participating in the study procedures and/or potentially afftecting the study quality data.