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MINERVA UROLOGICA E NEFROLOGICA

A Journal on Nephrology and Urology


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  XIV CONGRESS OF THE SOCIETA' ITALIANA DI NEFROLOGIA SEZIONE PIEMONTE-VALLE D'AOSTA
(Ivrea, October 5, 1996)


Minerva Urologica e Nefrologica 1998 March;50(1):91-5

language: Italian

Treatment of heart failure refractory to conventional therapy. Role of chronic ambulatory peritoneal dialysis and of Dobutamine intermittent infusion

Sacco A. 1, Agliata S. 1, Schweiger K. 1, Cavagnino A. 1, Bosimini E. 2, Corrà U. 2, Giannuzzi P. 2

1 Ospedale di Borgomanero (Novara), Servizio di Nefrologia e Dialisi;
2 Clinica del Lavoro - Veruno (Novara)


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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 continous ambulatory peritoneal dialysis (CPAD: 20 patients) or dobutamine intermittent infusions (DOB: 11 patients) was analysed: the mean dobutamin dose was 5γ/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.

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