Efficacy of Continuous Hemodiafiltration for Patients with Congestive Heart Failure

Abstract

Background/Aims: The basic principle of treatment of congestive heart failure is achieving adequate control of preload and afterload through enhancement of cardiac contractility. In severe cases, however, we have usually applied continuous hemodiafiltration (CHDF) as a type of mechanical support. In this study, we investigated hemodynamic changes caused by CHDF in patients with congestive heart failure. Methods: We treated seven patients with congestive heart failure complicated by multiple organ failure by CHDF over 72 h, during which we measured hemodynamic parameters to determine their changes. Results: Implementation of CHDF resulted in a significant decrease in pulmonary artery occluded pressure and significant increases in cardiac index and left ventricular stroke work index. In addition, 72-hour cumulative water balance was found to be –1,791 ± 2,119 ml, and systemic vascular resistance index decreased significantly. Conclusion: Hemodynamics of patients were improved with CHDF through strict control of preload and consequently tissue oxygen metabolism was improved.

A positive fluid balance is associated with a worse outcome in patients with acute renal failure

“…Indeed, in a recent review, Mehta and colleagues [ 18 ] concluded that there are no established guidelines for the modulation of fluid balance by means of diuretics or RRT in patients with organ dysfunction. Although diuretics can influence fluid balance, there is no evidence that their use can alter outcome in ARF [ 19 ], and the evidence for a beneficial effect of RRT on outcome in patients with multiple organ failure is also debated [ 20 - 22 ]. The findings of the present study should stimulate further studies to investigate the role of fluid balance on prognosis in these patients.…”

The Change in Renal Replacement Therapy on Acute Renal Failure in a General Intensive Care Unit in a University Hospital and its Clinical Efficacy: A Japanese Experience

“…Continuous hemodiafiltration had favorable effects on blood pressure and urine output not only because it had a less adverse effect on hemodynamics, but also because continuous elimination of cytokines and other humoral mediators responsible for unstable hemodynamics was possible in this group. We have frequently reported that CHDF is effective in eliminating humoral mediators and other toxic substances (18–22). Bellomo et al (23) and Bohrer et al (24) have also reported that CHDF is effective in eliminating humoral mediators.…”

Efficacy and Safety of Continuous Hemodiafiltration for Acute Decompensated Heart Failure

“…6,[10][11][12] CHDF therapy has also been reported to be effective in the treatment of CHF. 8) Furthermore, CHDF is being anticipated as a superior method for cytokine excision 8) compared with ultrafiltration. Cytokine excision may be effective in heart failure treatment.…”

“…6,7) It has been reported that continuous hemodiafiltration (CHDF) is also a possible alternative volume reduction therapy for diuretics and is being anticipated as a method for cytokine excision. 8) However, there is not enough data available on its efficacy and safety. We therefore conducted this study to evaluate the efficacy and safety of CHDF therapy for acute decompensated heart failure (ADHF).…”