Bertoli Silvio V, Ciurlino Daniele, Maccario Massimo, Martino Stefania, Bigatti Giada, Traversi Lara, Procaccio Mirella, Buzzi Laura
Renal Unit, Policlinico MultiMedica, Sesto San Giovanni, Milan, Italy.
Adv Perit Dial. 2005;21:123-7.
Congestive heart failure (CHF), mainly because of ischemic heart disease, is becoming a common medical problem. As CHF worsens and reaches New York Heart Association (NYHA) class IV, many patients can become refractory to medical therapy, especially those who are elderly or who have pre-existing non uremic chronic renal failure. For such patients, quality of life, morbidity, and mortality are expected to be bad. Our objective in the present study was to make a preliminary assessment of the usefulness of icodextrin administered in a single nocturnal peritoneal exchange to patients nonrespondent to the maximal conventional medical therapy. We studied two patients (aged 80 and 87 years), who were affected by severe dilatative cardiomyopathy and moderate-to-severe chronic renal failure. After at least 12 months of treatment, we observed a significant improvement in quality of life and a reduction in morbidity and hospitalization in both patients. Both patients also significantly increased their creatinine clearance. One patient maintained ejection fraction stability (22%-->27%); the other experienced an increase in ejection fraction to 50%from 25%. These preliminary observations suggest that a single nocturnal exchange with icodextrin can be an effective treatment in patients affected by refractory CHF and moderate-to-severe chronic renal failure.
充血性心力衰竭（CHF）主要由缺血性心脏病引起，正成为一个常见的医学问题。随着CHF病情恶化并达到纽约心脏协会（NYHA）IV级，许多患者可能对药物治疗产生耐药性，尤其是老年患者或已有非尿毒症慢性肾衰竭的患者。对于这类患者，生活质量、发病率和死亡率预计都很差。我们在本研究中的目的是初步评估在单次夜间腹膜透析中给予艾考糊精对最大常规药物治疗无反应的患者的有效性。我们研究了两名患者（年龄分别为80岁和87岁），他们患有严重扩张型心肌病和中度至重度慢性肾衰竭。经过至少12个月的治疗，我们观察到两名患者的生活质量均有显著改善，发病率和住院率均有所降低。两名患者的肌酐清除率也显著提高。一名患者维持射血分数稳定（22%→27%）；另一名患者的射血分数从25%增加到50%。这些初步观察结果表明，对于难治性CHF和中度至重度慢性肾衰竭患者，单次夜间使用艾考糊精进行腹膜透析可能是一种有效的治疗方法。
