Treatment of Congestion in Congestive Heart Failure: Ultrafiltration Is the Only Rational Initial Treatment of Volume Overload in Decompensated Heart Failure

Bart, Bradley A.

doi:10.1161/circheartfailure.109.863381

Cited by 65 publications

(47 citation statements)

References 46 publications

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“…Potential advantages of UF include greater control over the rate and volume of fluid removal, greater net loss of sodium, and less neurohormonal activation. 31) However, the efficacy and safety of UF are still controversial. The RAPID CHF trial 18) showed that UF resulted in more fluid removal and weight loss than loop diuretics without affecting renal function, while Rogers 20) found that there were no differences in fluid removal or weight loss between the UF and loop diuretics groups.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Ultrafiltration in Decompensated Heart Failure Patients With Renal Insufficiency

Zhong

Wang

et al. 2015

Int. Heart J.

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SummaryUltrafiltration (UF) is an alternative strategy to diuretic therapy for the treatment of patients with decompensated heart failure. The impact of UF in decompensated heart failure with renal insufficiency remains unclear.A literature search was conducted for randomized controlled trials (RCTs) that investigated the use of UF in decompensated heart failure patients with renal insufficiency.Seven RCTs with 569 participants were eligible for analysis. There was significantly more 48 hour weight loss (WMD 1.59, 95% CI 0.32 to 2.86; P = 0.01; I2 = 68%) and 48 hour fluid removal (WMD 1.23, 95% CI 0.63 to 1.82; P < 0.0001; I2 = 43%) in the UF group compared to the control group. Serum creatinine (WMD 0.05; 95% CI -0.23 to 0.33; P = 0.61; I2 = 77%) and serum creatinine changes (WMD 0.05; 95% CI -0.15 to 0.26; P = 0.61; I2 = 77%) were similar between the UF and control groups. All-cause mortality (OR 0.95; 95% CI 0.58 to 1.55; P = 0.83; I2 = 0.0%) and all-cause rehospitalization (OR 0.97; 95% CI 0.49 to 1.92; P = 0.94; I2 = 52%) were also similar between the UF and control groups. Adverse events such as infection, anemia, hemorrhage, worsening heart failure, and other cardiac disorders did not differ significantly between the UF and control groups.UF is an effective and safe therapeutic strategy and produces greater weight loss and fluid removal without affecting renal function, mortality, or rehospitalization in patients with decompensated heart failure complicated by renal insufficiency. (Int Heart J 2015; 56: 319-323)

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Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Ultrafiltration in Decompensated Heart Failure Patients With Renal Insufficiency

Zhong

Wang

et al. 2015

Int. Heart J.

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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.…”

mentioning

confidence: 99%

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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“…Prior studies reported that ultrafiltration enabled more effective sodium elimination when compared to diuretics with a lower degree of neurohormonal activation (12)(13)(14). In another study by Marenzi et al, patients who underwent ultrafiltration had lower levels of plasma norepinephrine, renin, and aldosterone (15).…”

Section: Türk Nefroloji Diyaliz Ve Transplantasyon Dergisi Turkish Nementioning

confidence: 99%

Comparison of Ultrafiltration and Intravenous Diuretic Therapies in Patients Hospitalized for Acute Decompensated Biventricular Heart Failure

Şeker¹,

Kayataş²,

Hüzmelí³

et al. 2016

Turk Neph Dial Transpl

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OBJECTIVE: Studies comparing ultrafiltration and diuretics in management of ADHF have shown controversial results. In this study, we compared the efficacy and safety of intravenous diuretic therapy and ultrafiltration in patients admitted with acute decompensated heart failure (ADHF) who had right ventricular dysfunction superimposed on left ventricular systolic dysfunction. MATERIAL and METHODs:A total of 30 patients of whom 10 were in the ultrafiltration group and 20 were in the diuretic group were enrolled in this study and followed for 3 months.REsULTs: At discharge, there were no significant differences between the ultrafiltration and diuretic groups in terms of weight loss , total fluid loss, and changes in serum creatinine. The clinical decongestion rates were similar in the two groups. Moreover, echocardiographic and biochemical parameters and alterations in renin and aldosterone levels, as measured to assess neurohormonal activation, had overlapping results between the two groups. When unwanted events were analyzed, transition to hemodialysis was seen in 20% of the patients in the ultrafiltration group and 5% of the patients in the diuretic group. The frequency of cardiac arrest and death were 40% in the ultrafiltration group and 10% in the diuretic group. Weight change, creatinine, and electrolyte levels of the patients at 1 and 3 months were also similar. CONCLUsION:Despite the high frequency of hemodialysis transition, cardiac arrest, and death in the ultrafiltration group, safety of ultrafiltration could not be assessed because of inability to perform statistical analyses. Further studies are needed to investigate the practical uses of ultrafiltration in routine clinical practice.

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Treatment of Congestion in Congestive Heart Failure: Ultrafiltration Is the Only Rational Initial Treatment of Volume Overload in Decompensated Heart Failure

Cited by 65 publications

References 46 publications

Efficacy and Safety of Ultrafiltration in Decompensated Heart Failure Patients With Renal Insufficiency

Efficacy and Safety of Ultrafiltration in Decompensated Heart Failure Patients With Renal Insufficiency

Diuretics and Ultrafiltration in Acute Heart Failure Syndrom

Comparison of Ultrafiltration and Intravenous Diuretic Therapies in Patients Hospitalized for Acute Decompensated Biventricular Heart Failure

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