Ultrafiltration – ABC CARDIOL

ABCHF

Review Article

Treatment Strategies for Refractory Congestion

Germana Porto Linhares et al. João Davi Souza Neto

Abstract

Worsening congestion is the main reason for hospitalization of most acute heart failure (AHF) patients. However, most patients are discharged with residual congestion, resulting in early readmissions that portend poor outcomes. Diuretics remain the mainstay of therapy. Nevertheless, these drugs stimulate the renin-angiotensin–aldosterone (RAA) axis and the sympathetic system and elicit adaptive responses in the nephron that may be counterproductive and lead to diuretic resistance. Renal failure and AHF are common and coexist in up to 40% of cases. Diuretic strategies that rely on combinations of diuretics are emphasized as a method to prevent resistance. If diuretic resistance does develop, higher-dose combination regimens, hypertonic saline solution, and mechanical ultrafiltration can be used to overcome diuretic adaptations and restore diuretic efficacy.

Read Full Article

ABC

Review Article

Meta-Analysis of Ultrafiltration versus Diuretics Treatment Option for Overload Volume Reduction in Patients with Acute Decompensated Heart Failure

Barkoudah Ebrahim et al. Kodali Sindhura Juliet Okoroh Rosh Sethi … Edward Hulten Claudia Suemoto Marcio Sommer Bittencourt

Introduction:

Although diuretics are mainly used for the treatment of acute decompensated heart failure (ADHF), inadequate responses and complications have led to the use of extracorporeal ultrafiltration (UF) as an alternative strategy for reducing volume overloads in patients with ADHF.

Objective:

The aim of our study is to perform meta-analysis of the results obtained from studies on extracorporeal venous ultrafiltration and compare them with those of standard diuretic treatment for overload volume reduction in acute decompensated heart failure.

Methods:

MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials databases were systematically searched using a pre‑specified criterion. Pooled estimates of outcomes after 48 h (weight change, serum creatinine level, and all-cause mortality) were computed using random effect models. Pooled weighted mean differences were calculated for weight loss and change in creatinine level, whereas a pooled risk ratio was used for the analysis of binary all-cause mortality outcome.

Results:

A total of nine studies, involving 613 patients, met the eligibility criteria. The mean weight loss in patients who underwent UF therapy was 1.78 kg [95% Confidence Interval (CI): −2.65 to −0.91 kg; p < 0.001) more than those who received standard diuretic therapy. The post-intervention creatinine level, however, was not significantly different (mean change = −0.25 mg/dL; 95% CI: −0.56 to 0.06 mg/dL; p = 0.112). The risk of all-cause mortality persisted in patients treated with UF compared with patients treated with standard diuretics (Pooled RR = 1.00; 95% CI: 0.64–1.56; p = 0.993).

Conclusion:

Compared with standard diuretic therapy, UF treatment for overload volume reduction in individuals suffering from ADHF, resulted in significant reduction of body weight within 48 h. However, no significant decrease of serum creatinine level or reduction of all-cause mortality was observed.