Ultrafiltration for management of fluid overload in patients with heart failure

Clinical Cardiology, 1988

Artificial subtraction of fluids and solutes was evaluated in the course of acute and chronic heart failure when it became refractory to standard intensive medical treatment. A group of 19 patients (mean age 57 years), 9 with ischemic, 2 amyloidotic, 4 valvular, and 4 idiopathic cardiomyopathy, were treated. In 17 patients extracorporeal ultrafiltration (UF) by means of a polysulfonate ultrafilter was adopted along 125 sessions (105 assisted by a roller pump and 20 as a slow continuous ultrafiltrate). In two patients continuous peritoneal dialysis was adopted. In every case UF was well tolerated. Ultrafiltrate volumes ranged from 1680 to 3500 ml for every session with corresponding Na losses ranging from 194 to 434 mEq/session. Improved clinical and functional status with reduction of edema was observed in 17 of 19 patients. In 12 patients UF could be discontinued due to restored response to diuretics; 5 of these patients could subsequently undergo heart surgery (1 transplant, 3 valve replacement, 1 coronary bypass). The remaining 7 patients survived on medical therapy alone for an average of 228 days. In 7 of 19 cases, UF could not be discontinued, and these patients died after an average of 23 days of treatment. In conclusion, UF proved to be effective in eliminating salt-fluid overload and restoring response to medical treatment. Patients who are potential surgical candidates seem to be the most suitable for UF.

Current Opinion in Cardiology, 2010

Journal of cardiovascular medicine (Hagerstown, Md.), 2010

We report our experience with ultrafiltration to remove fluid overload in patients with diuretic-resistant, decompensated, congestive heart failure. From 2005 to 2008, 42 patients with heart failure and left ventricular ejection fraction less than 40% were treated with ultrafiltration. Patients were hospitalized for acute decompensation. Mean age was 69 years (67% men). Cause of heart failure was ischemic in 52% of cases. New York Heart Association (NYHA) class was III (64%) or IV (36%). All patients were on optimal heart failure drugs. Average dose of furosemide before ultrafiltration was 250 mg. Exclusion criteria were contraindications to anticoagulants, hematocrit more than 50%, glomerular filtration rate less than 30 ml/min and cardiogenic shock. Ultrafiltration was performed using a venous femoral bilumen catheter and anticoagulation with heparin. Each patient underwent one to four ultrafiltration treatments (total 70). Mean duration of a treatment was 6 h. Eighty-six percent ...

Turkish Journal of Internal Medicine, 2020

Hypervolemia is an important consequence of heart failure (HF) that leads poor quality of life and frequent hospitalizations. Ultrafiltration (UF) with dialysis is an option for HF patients who are resistant or inappropriate for diuretics. Peritoneal dialysis (PD) can be a long-term efficient solution for hypervolemia in appropriate HF patients. We retrospectively evaluated PD patients in our center in order to determine the ones whose indication was UF for volume control because of HF between January 2015 and January 2020. Results 4 (2 females, 68.75±4.27 years old) HF patients who had poor volume control on diuretic based regimen were on PD for UF. PD treatment was planned as a daily single exchange with icodextrin in whom all had preserved renal function. In one patient one daily exchange with an amino acid-based PD solution was added. Exchange volume was between 1000 and 1500 mL, dwell time was 9 to 14 hours and UF was 200 to 1100 mL. During the follow-up patients lost adequate weight and none of them were hospitalized because of hypervolemia. Conclusions UF through PD in HF patients provides effective volume control, relief of symptoms and avoids frequent hospitalizations. A single daily exchange with icodextrin can be adequate for hypervolemic, well selected HF patients.

Journal of the American College of Cardiology, 2017

More than 1 million heart failure hospitalizations occur annually, and congestion is the predominant cause. Rehospitalizations for recurrent congestion portend poor outcomes independently of age and renal function. Persistent congestion trumps serum creatinine increases in predicting adverse heart failure outcomes. No decongestive pharmacological therapy has reduced these harmful consequences. Simplified ultrafiltration devices permit fluid removal in lower-acuity hospital settings, but with conflicting results regarding safety and efficacy. Ultrafiltration performed at fixed rates after onset of therapy-induced increased serum creatinine was not superior to standard care and resulted in more complications. In contrast, compared with diuretic agents, some data suggest that adjustment of ultrafiltration rates to patients' vital signs and renal function may be associated with more effective decongestion and fewer heart failure events. Essential aspects of ultrafiltration remain po...

Heart Failure Reviews, 2020

Studies on the effectiveness of ultrafiltration (UF) in patients hospitalized with acute decompensated heart failure (ADHF) have led to heterogeneous study outcomes. This meta-analysis aimed to assess the impact of UF therapy in ADHF patients. We searched the medical literature to identify well-designed studies comparing UF with the usual diuretic therapy in this setting. Systematic evaluation of 8 randomized controlled trials enrolling 801 participants showed greater fluid removal (difference in means 1372.5 mL, 95% CI 849.6 to 1895.4 mL; p < 0.001), weight loss (difference in means 1.592 kg, 95% CI 1.039 to 2.144 kg; p < 0.001) and lower incidences of worsening heart failure (OR 0.63, 95% CI 0.43 to 0.94, p = 0.022) and rehospitalization for heart failure (OR 0.54, 95% CI 0.36 to 0.82, p = 0.003) without a difference in renal impairment (OR 1.386, 95% CI 0.870 to 2.209; p = 0.169) or all-cause mortality (OR 1.13, 95% CI 0.75 to 1.71, p = 0.546). UF increases fluid removal an...

Medical Science Monitor, 2011

Diuretic-resistant congestive heart failure in the form of type 2 cardiorenal syndrome is a problem of growing significance in everyday clinical practice because of high morbidity and mortality. There has been scant progress in the treatment of overhydration, the main cause of symptoms in this group of patients. The aim of our review is to present recent advances in the ultrafiltration therapy of congestive heart failure, with special attention to the new dedicated device for extracorporeal isolated ultrafiltration, as well as modifications of peritoneal dialysis in the form of peritoneal ultrafiltration with icodextrin solution and incremental peritoneal dialysis. Technical and clinical features, costs and potential risks of available devices for isolated ultrafiltration are presented. This method should be reserved for patients with true diuretic resistance as part of a more complex strategy aiming at the adequate control of fluid retention. Peritoneal ultrafiltration is presented as a viable alternative to extracorporeal ultrafiltration because of medical and psychosocial benefits of home-based therapy, lower costs and more effective daily ultrafiltration. In conclusion, large, properly randomized and controlled clinical trials with long-term follow-up will be essential in assessing the logistics and cost-effectiveness of both methods. Most importantly, however, they should be able to evaluate the impact of both methods on preservation of renal function and delaying the progression of heart failure by interrupting the vicious circle of cardiorenal syndrome. Our review is supplemented with the case report of the use of peritoneal ultrafiltration with a single 12-hour nighttime icodextrin exchange as a life-saving procedure in a patient with congestive heart failure resistant to pharmacological treatment.

American Heart Journal, 2011

Fluid overload is a key pathophysiologic mechanism underlying both the acute decompensation episodes of heart failure and the progression of the syndrome. Moreover, it represents the most important factor responsible for the high readmission rates observed in these patients and is often associated with renal function worsening, which by itself increases mortality risk. In this clinical context, ultrafiltration (UF) has been proposed as an alternative to diuretics to obtain a quicker relief of pulmonary/ systemic congestion. This review illustrates technical issues, mechanisms, efficacy, safety, costs, and indications of UF in heart failure. The available evidence does not support the widespread use of UF as a substitute for diuretic therapy. Owing to its operative characteristics, UF cannot be expected to directly influence serum electrolyte levels, azotemia, and acid-base balance, or to remove high-molecular-weight substances (eg, cytokines) in clinically relevant amounts. Ultrafiltration should be used neither as a quicker way to achieve a sort of mechanical diuresis nor as a remedy for an inadequately prescribed and administered diuretic therapy. Instead, it should be reserved to selected patients with advanced heart failure and true diuretic resistance, as part of a more complex strategy aiming at an adequate control of fluid retention. (Am Heart J 2011;161:439-49.) From the

American Journal of Kidney Diseases, 1996

Slow isolated ultrafiltration (UF) was used to remove excess water and sodium in refractory congestive heart failure (CHF) patients. Fifty-two patients (40 men, 12 women; age, 63.8 ± 10.2 years) presenting with CHF (class IV, New York Heart Association (NYHA)) were included in the study. Forty-one patients had normal renal function, and 11 patients had various degrees of renal failure

Journal of Cardiac Failure, 2014

Background. There are limited data comparing ultrafiltration with standard medical therapy as first-line treatment in patients with severe congestive heart failure (HF). We compared ultrafiltration vs. conventional therapy in patients hospitalized for HF and overt fluid overload.