Efficacy and Safety of Continuous Hemodiafiltration for Acute Decompensated Heart Failure

Shiomi, Hiroki; Matsubara, Kazuo; Ariyoshi, Makoto; Iwamura, Yumi; Fukui, Kensuke; Sakamoto, T.; Sawanishi, Takayoshi; Shima, Masami; Furukawa, Koichi

doi:10.1536/ihj.51.247

Cited by 10 publications

(7 citation statements)

References 19 publications

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“…Vol 54 No 6 DIURETICS AND ULTRAFILTRATION IN AHFS Data extraction: Data extraction was performed by two independent reviewers using a standardized data-collection form, and disagreements were resolved by discussion. The details extracted were patient characteristics, study quality, and clinical outcomes that included all-cause mortality, heart failure, and rehospitalization in both the diuretic and ultrafiltration groups.…”

Section: Methodsmentioning

confidence: 99%

Section: )mentioning

confidence: 99%

“…Several small studies suggest that ultrafi ltration may allow for greater net fl uid removal, less neurohormonal activation, and improved quality of life and reduced rehospitalization rates. [4][5][6] However, the CARRESS-HF trial. 7) reported that diuretic-therapy was superior to ultrafi ltration, so the optimal method for successful decongestion while minimizing changes in renal function and neurohormonal activation remains unclear.…”

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confidence: 99%

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Diuretics and Ultrafiltration in Acute Heart Failure Syndrom

Liang

2013

Int. Heart J.

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SummaryThe use of diuretics and ultrafi ltration in acute heart failure syndrome (AHFS) has been investigated in a number of randomized controlled trials (RCTs). However, the benefi ts have been variable. We therefore performed a meta-analysis to examine the overall effect of all-cause mortality, rehospitalization, renal function, dyspnea relief, and adverse events in patients with AHFS. We identifi ed RCTs by a systematic search of MEDLINE, EMBASE, and the Cochrane Controlled Clinical Trials Register Database. Eligible RCTs were those that enrolled patients with AHFS and involved comparison of diuretic versus ultrafi ltration therapy. Five RCTs with a total of nearly 500 patients were included. Overall, ultrafi ltration therapy was not associated with signifi cantly decreased risk of all-cause mortality (relative risk [RR], 0.977; 95% confi dence interval [CI], 0.602 to 1.587; P = 0.925; I 2 = 0.0%), rehospitalization (RR, 0.903; 95% CI, 0.696 to 1.170; P = 0.440; I 2 = 77.4%), dyspnea score (weighted mean difference [WMD], 0.168; 95% CI, -0.318 to 0.653; P = 0.498; I 2 = 11.4%) and creatinine (WMD, 0.055 mg/mL; 95% CI, -0.101 to 0.210; P = 0.491; I 2 = 48.4%). However, there was signifi cantly more weight loss (WMD, 1.333 kg; 95% CI, 0.186 to 2.479; P = 0.023; I 2 = 57.7%) and net fl uid removal (WMD, 1459.432 mL; 95% CI, 275.911 to 2642.953; P = 0.016; I 2 = 25.2%) in the ultrafi ltration-therapy group. There was no signifi cant difference in the risk of adverse events between the two groups. Compared with diuretic therapy, ultrafi ltration produces greater weight loss and net fl uid removal in a safe and effective manner. (Int Heart J 2013; 54: 390-394) Key words: Renal function H eart failure is a major and growing public health problem worldwide, and there is a pressing need to improve outcomes and decrease costs. 1) Although there have been therapeutic advances in the HF drug treatment of chronic HF, the prognosis of patients with acute heart failure syndrome (AHFS) remains poor.1) Fluid retention is responsible for nearly 90% of HF hospitalizations, and intravenous loop diuretics remain the fi rst-line therapy for AHFS.2) However, the effi cacy of loop diuretics is balanced by the limitations of diuretic resistance, neurohormonal activation, and worsening renal function. 3)Peripheral venovenous ultrafi ltration represents an alternative approach in this setting. Several small studies suggest that ultrafi ltration may allow for greater net fl uid removal, less neurohormonal activation, and improved quality of life and reduced rehospitalization rates. [4][5][6] However, the CARRESS-HF trial.7) reported that diuretic-therapy was superior to ultrafi ltration, so the optimal method for successful decongestion while minimizing changes in renal function and neurohormonal activation remains unclear. The aim of the present study was to evaluate the risk of all-cause mortality, rehospitalization, renal function, weight change, and adverse events by conducting a meta-analysis of RCTs of diuretic versus ultrafi ltra...

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confidence: 99%

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Diuretics and Ultrafiltration in Acute Heart Failure Syndrom

Liang

2013

Int. Heart J.

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“…In addition, amyloid patients with renal involvement and severe heart failure develop resistance to diuretics. It was reported recently that CHDF can control fluid volume in volumeoverloaded heart failure and cardiogenic shock without changing the hemodynamic state (8). Thus, CHDF therapy is safe and effective in hemodynamically unstable patients.…”

Section: Discussionmentioning

confidence: 97%

Multidisciplinary Mechanical Supports Improve Outcome in a Shock Patient with Cardiac Amyloidosis: A Case Report

et al. 2012

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Shock patients with restrictive cardiomyopathy due to cardiac amyloidosis are refractory to medical treatment. Here, we report a case of early initiation of intra-aortic balloon pumping (IABP) in a patient with cardiac amyloidosis who developed postoperative shock. Continuous hemodiafiltration was also applied to control circulating fluid volume. The mechanical treatments allowed reduction of the doses of catecholamine and diuretics and resulted in full recovery. It is reasonable to initiate IABP and hemofiltration dialysis during the early stages for the appropriate control of hemodynamics and fluid in shock patients with cardiac amyloidosis.

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“…In the HC group, an increase in the Hb level was inversely correlated with a decrease in BW during the first 3 days of admission, which was considered a natural consequence of the loss of intravascular fluid volume. [14][15][16][17][18] Contrastingly, despite reduction in patient BW, Hb levels decreased in the HD group during the first 3 days of admission. This paradoxical phenomenon has been reported in previous studies.…”

Section: Discussionmentioning

confidence: 99%

Hemodilution after Initial Treatment in Patients with Acute Decompensated Heart Failure

et al. 2018

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Decongestion is an important goal of heart failure (HF) management. Blood cell concentration is a recognized indicator for guiding decongestive treatment for HF. We aimed to assess the clinical impact of hemodilution and hemoconcentration after initial treatment in acute decompensated HF (ADHF) patients. We retrospectively evaluated hemoglobin levels and body weight obtained before admission, on admission, 3 days after admission, and at discharge in 102 consecutive patients admitted with ADHF. Patients were then stratified into hemodilution (n = 55) and hemoconcentration (n = 47) groups based on whether their hemoglobin levels decreased or increased, respectively, during the first 3 days after admission. From before admission to admission, hemoglobin levels decreased less in the hemodilution group (-0.16 ± 0.98 g/dL) than in the hemoconcentration group (-0.88 ± 1.11 g/dL) (P < 0.001); however, there was no significant difference in body weight (P≥ 0.05). More patients in the hemodilution group (85%) had grade III/IV pulmonary edema (Turner's criteria) compared with the hemoconcentration group (63%) (P < 0.01). Rate of readmission for HF within 180 days of discharge was higher in the hemodilution group (34%) compared with the hemoconcentration group (9%) (P < 0.01). Hemodilution after initial treatment for ADHF was associated with severe pulmonary edema at admission and higher readmission rates.

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Efficacy and Safety of Continuous Hemodiafiltration for Acute Decompensated Heart Failure

Cited by 10 publications

References 19 publications

Diuretics and Ultrafiltration in Acute Heart Failure Syndrom

Diuretics and Ultrafiltration in Acute Heart Failure Syndrom

Multidisciplinary Mechanical Supports Improve Outcome in a Shock Patient with Cardiac Amyloidosis: A Case Report

Hemodilution after Initial Treatment in Patients with Acute Decompensated Heart Failure

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