• 6 min Walking distance [ Time Frame: At 3 and 6 months ]
  Change from the baseline
• Quality of life tested with Minnesota Living with Heart Failure Questionnaire [ Time Frame: At 3 and 6 months ]
  Change from the baseline
• Number of patients with decrease of NT pro-BNP (N-terminal pro brain natriuretic peptide) [ Time Frame: At 3 and 6 months ]
  The number of patients with a decrease in NT pro-BNP level of ≥25% from baseline
• Worsening of renal function [ Time Frame: Up to 6 months ]
  Estimated Glomerular Filtration Rate (eGFR) ≤20 ml/min
• Cumulative daily dosage of loop diuretic [ Time Frame: 6 months ]
  Change over the 6 months of study treatment,
• Use of hospital resources [ Time Frame: 6 months ]
  The number of days spent in-hospital because of HF exacerbation during the 6 months of study treatment
• New York Heart Association (NYHA) class [ Time Frame: At 1, 3 and 6 months ]
  Change from baseline
• Number of patients requiring hospitalization [ Time Frame: 6 months ]
  Hospitalization for infusional therapy with loop diuretic
• Number of patients increasing of ≥50% the initial daily dose of loop diuretic [ Time Frame: 6 months ]
  Change from baseline
• Adverse Events [ Time Frame: 6 months ]
  Information about all adverse events, whether volunteered by the patient, discovered by investigator questioning, or detected through physical examination, laboratory or instrumental test, will be collected, recorded and followed as appropriate.

• Drug: PolyCore (Polydextrin, L-Carnitine, D-xylitol)
  A single nightly exchange, with 2 liters PolyCore solution, lasting 12-14 hours. Patients should remain on their prescribed heart failure medications and the same dosing schedule for the duration of the study unless investigators determine medically necessary to change.
  Other Name: PolyCore peritoneal dialysis solution
• Drug: Medical therapy including loop diuretic (furosemide) daily dose up to 2.5 mg/kg/day,
  During the study, patients should remain on their prescribed heart failure medications and the same dosing schedule for the duration of the study unless investigators determine medically necessary to change.
  Other Name: Guidelines directed medical therapy

• Experimental: PolyCore PUF
  PolyCore peritoneal ultrafiltration (PUF) (over the top of patient's prescribed heart failure medications), for 6 months.
  Intervention: Drug: PolyCore (Polydextrin, L-Carnitine, D-xylitol)
• Active Comparator: Control
  Patients in the control arm (receiving no PUF therapy) will remain on their prescribed heart failure medications.
  Intervention: Drug: Medical therapy including loop diuretic (furosemide) daily dose up to 2.5 mg/kg/day,

Inclusion Criteria:

• Age ≥18 yrs
• ≥ 3 months follow-up in the clinic
• Left ventricular ejection fraction ≤40%
• NYHA Classification of III-IV despite guidelines directed medical therapy
• Hospitalized for heart failure
• Right ventricular failure due to after load mismatch, addressed by the presence of tricuspid valve regurgitation 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 (furosemide) dose till to 2.5mg/kg/day, coupled with urinary sodium excretion ≤ 70 mEq/L/day, confirmatory of loop diuretic resistance (4).
• 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.
• The presence of at least one hospitalization for HF lasting 3 days or more in the 6 months before the study enrolment
• An appropriate PUF technique candidate.
• Signed informed consent

Exclusion Criteria:

• Recipients of heart transplantation
• Presence of a mechanical circulatory support device;
• Isolated Right Heart Failure;
• Isolated Left Ventricular diastolic dysfunction;
• Hypertrophic obstructive cardiomyopathy;
• 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;
• Pregnancy;
• Unwilling and unable to give informed consent;
• Enrolment in another clinical trial involving medical or device based interventions.