Peritoneal dialysis is an important form of kidney replacement therapy. Most patients presenting with an unplanned, urgent need for dialysis are prescribed haemodialysis, leading to peritoneal dialysis underutilisation. Urgent-start peritoneal dialysis refers to treatment that is commenced within 2 weeks of catheter placement. Urgent-start peritoneal dialysis represents an efficacious, cost-effective alternative to the conventional approach of commencing dialysis. There is a paucity of evidence to guide management, however experience with the technique is increasing. This article overviews the rationale and practical application of urgent-start peritoneal dialysis.Dobutamine is a weak Beta-1 and a potent Beta-2 adrenergic agonist commonly used to treat patients in cardiogenic shock. It enhances myocardial contractibility, increasing cardiac output. Myoclonus in patients receiving an infusion of dobutamine is rare and, although not fully understood, seems more common in patients with severe kidney failure. To our knowledge, this is the first reported case of dobutamine-induced myoclonus in a patient with kidney failure receiving peritoneal dialysis.

Only 7% of the 518,749 of the US population requiring kidney replacement therapy are treated by peritoneal dialysis with only a small unknown number of those, with advanced heart failure managed with an infusion of inotropic medication. The low prevalence of combined advanced heart failure and kidney failure could partly explain this condition’s rarity. Herein, we report a case of a woman in her 60s with kidney failure treated by peritoneal dialysis who developed myoclonus three weeks after starting a dobutamine infusion for advanced refractory heart failure. Infectious and other pharmacological causes of myoclonus were ruled out. Initially, uremia was suspected, but despite increasing her peritoneal dialysis dose, it was only after discontinuing the dobutamine that her myoclonus resolved.

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Mishita
Jornal co-ordinator
 Journal of Clinical & Experimental Nephrology