[Is intermittent peritoneal dialysis with icodextrin a valid option in the long-term treatment of refractory congestive heart failure?].
Refractory congestive heart failure (CHF) is affected by a very high morbidity and mortality. We report our experience in the long-term treatment of refractory CHF (NYHA class IV) by means of intermittent peritoneal dialysis (PD) with icodextrin (ICO) solutions in 4 male patients with a mean age of 71.5 + or - 5.6 (standard deviation) years and with a variable degree of chronic renal failure: 1 nocturnal exchange with ICO in 3 patients and 2 exchanges (ICO + isotonic dextrose solution) in 1 patient. The mean PD follow-up period was 24.3 + 15.6 months. After stabilization on PD, all patients had a statistically significant increase in daily diuresis (from 587.5 + or - 165.2 to 1700.0 + or - 141.4 mL, p < 0.003), a statistically significant decrease in body weight (11.3 + or - 3.4 kg, p < 0.007), and a statistically significant improvement in NYHA class (from 4.0 + or - 0.0 to 2.5 + or - 2.6, p < 0.01). Three patients had no hospitalizations due to cardiac illness in the PD follow-up period. No episodes of peritonitis occurred. Three patients died after 11, 13 and 43 months of PD treatment: 2 because of sudden death and 1 because of neoplastic cachexia. No death could be attributed to any complication related to PD treatment. Intermittent PD with ICO solutions can be proposed as a long-term treatment modality for refractory CHF. It allows an improvement in quality - if not quantity - of life. Randomized controlled trials are needed to confirm the evidence derived from case reports.
Basile
C
C
Unita' Operativa Complessa di Nefrologia e Dialisi, Ente Ecclesiastico Ospedale Generale Regionale ''F. Miulli'', Acquaviva delle Fonti (BA), Italy. basile.miulli@libero.it
Chimienti
D
D
Bruno
A
A
Cocola
S
S
Libutti
P
P
Teutonico
A
A
Cazzato
F
F
D000368:Aged; D015314:Dialysis Solutions / Q000627:therapeutic use*; D005500:Follow-Up Studies; D005936:Glucans / Q000627:therapeutic use*; D005947:Glucose / Q000627:therapeutic use*; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D000077607:Icodextrin; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000379:methods*; D013997:Time Factors
D015314:Dialysis Solutions; D005936:Glucans; D000077607:Icodextrin; D005947:Glucose