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[Peritoneal dialysis and chronic dobutamine, two experiences contrasted. Possible role and indications in refractory
A Sacco1, S Agliata, K Schweiger
1Servizio di Nefrologia e Dialisi, Ospedale di Borgomanero, Novara.
Insights
Continuous ambulatory peritoneal dialysis (CAPD) and dobutamine intermittent infusions (DOB) show feasibility and potential for improving survival and quality of life in heart failure patients refractory to conventional therapy.
Area of Science:
- Cardiology
- Nephrology
- Critical Care Medicine
Background:
- Heart failure (HF) is a growing concern with poor prognosis in end-stage patients despite advanced pharmacological treatments.
- Limited research exists on non-conventional therapies for refractory HF.
- This study explores two such alternative approaches.
Purpose of the Study:
- To evaluate the feasibility and long-term efficacy of Continuous Ambulatory Peritoneal Dialysis (CAPD) and dobutamine intermittent infusions (DOB) in patients with end-stage heart failure.
- To assess survival rates and functional improvements in patients receiving these non-conventional treatments.
Main Methods:
- A non-randomized study analyzing 20 patients undergoing CAPD and 11 patients receiving DOB.
- DOB treatment involved a mean dose of 5 mcg/kg/min with varying infusion schedules.
- Feasibility and procedural complications were monitored.
Main Results:
- Both CAPD and DOB were feasible with no major complications.
- Six-month survival rates were 55% for CAPD and 36% for DOB.
- Twelve-month survival rates were 35% for CAPD and 18% for DOB.
- Overall one-year survival was 38%, with significant improvements in function and quality of life observed in survivors.
Conclusions:
- CAPD and DOB can be considered as viable options for patients with refractory HF when conventional therapies fail.
- These strategies may be particularly beneficial for patients amenable to home-based treatment.
- Further research is needed to identify specific patient subgroups that would benefit most from these interventions and to validate these findings.
Unlabelled:
The number of patients who develop heart failure (HF) is increasing and is expected to increase further in the next decade. Despite the availability of an ever-widening array of pharmacological therapy, patients with end-stage HF have a poor long-term prognosis. Little attention has been paid to alternative non-conventional therapy for these patients. The aim of this non-randomized study was to describe two non-conventional approaches in patients with HF, refractory to conventional medical therapy. The feasibility and long-term efficacy of a continuous ambulatory peritoneal dialysis (CPAD: 20 patients) or dobutamine intermittent infusions (DOB: 11 patients) was analysed: the mean dobutamin dose was 5 gamma/kg/min, and the interval period treatment ranged from 12 hours/day to 12 hours/week.
Results:
Both treatments were feasible and non major procedure complications occurred. The 6 and 12 month survival rates were 55% (14/20 patients), 35% (9/20 patients) and 36% (6/11 patients), 18% (3/11 patients) in the CAPD patients and DOB patients, respectively. All patients survived at one year (38% = 12/31 patients) documented a significant functional improvement and quality of life. The conclusions is drawn that the use of CAPD and DOB should be considered in those with refractory HF, in whom medical therapy has failed and in whom home training is considered feasible. Further studies are necessary to define those patients who will benefit from one of these strategies and to confirm these preliminary data.