High rate of recidivismreadmission rates remain stubbornly at 20% within 30 days and near 50% at 6 months inflection point in the natural history of heart failure with subsequent one year mortality rates that approximate 25% significant patient heterogeneity. Ultrafiltration should not replace diuretics for the. Decongestive treatment of acute decompensated heart failure. Ultrafiltration in decompensated heart failure disclaimerinstructions for use medical policy provides general guidance for applying blue cross of idaho benefit plans for purposes of medical policy, the terms benefit plan and member contract are used interchangeably. Ultrafiltration is the gold standard for sodiumvolume removal and is the only intervention shown to improve outcomes in a randomized controlled trial of patients hospitalized with decompensated heart failure. In the united states, more than 1 million patients are admitted annually for acute decompensated heart failure adhf. Diuretics on clinical, biohumoral and hemodynamic variables in patients with decompensated heart failure study, at 36 h, compared with the diuretic agent group, the uf patients had greater reduction in body weight, signs and symptoms of heart failure, aldosterone and nterminal probtype. Diuretics and ultrafiltration in acute decompensated heart. Most patients admitted for decompensated heart failure are by definition diureticresistant. Blood urea nitrogen and serum creatinine circulation. The identification of specific patients with decompensated heart failure dhf who may benefit from ultrafiltration uf is important in clinical practice. Sustained lowefficiency dialysis sled has the additional feature of dialysis fluid passed through the.
Ultrafiltration in decompensated heart failure n engl j med 367. While the costs associated with ultrafiltration during the index hospitalization may exceed those of intravenous diuretics, total cost over time may be lower due to decreased resource utilization for heart failure. Objectiveswe sought to determine if ultrafiltration before intravenous iv diuretics in patients with decompensated heart failure and diuretic resistance results in euvolemia and early discharge without hypotension or worsening renal function. In the ultrafiltration versus intravenous diuretics for patients hospitalized for acute decompensated heart failure unload trial, venovenous ultrafiltration for up to 48 hours was compared with intravenous diuretics in patients hospitalized for adhf. The outcomes included weight change, length of hospital stay, rehospitalization for hf, mortality, change in serum creatinine. Pdf ultrafiltration for decompensated heart failure. Ultrafiltration in decompensated heart failure with cardiorenal syndrome. Mittal division of cardiovascular medicine, university of missouri school of medicine, columbia, missouri, usa. Current research suggests that decompensated chf patients refractory to intravenous diuretics may benefit from uf therapy. Background ultrafiltration is an alternative strategy to diuretic therapy for the treatment of patients with acute decompensated heart failure. A practical guide for ultrafiltration in acute decompensated heart failure acute decompensated heart failure is the most common reason for inpatient hospital admission.
The impact of ultrafiltration in acute decompensated heart failure. Ultrafiltration system for salt and water removal using a low volume of extracorporeal blood through peripheral or central venous access chf solutions inc. Role of isolated ultrafiltration in the management of. The impact of ultrafiltration in acute decompensated heart. Pdf decongestive treatment of acute decompensated heart. Moreover, many patients with adhf are discharged without clinical evidence of adequate decongestion. Those in the uf group received an 8 hour uf treatment with a maximum fluid removal rate of 500 cc. Background ultrafiltration uf is a novel nonpharmacological therapy for decompensated chronic heart failure chf patients, although its precise clinical role remains unclear. Little is known about the efficacy and safety of ultr. Ultrafiltration is generally used for those with decompensated heart failure whose fluid overload is unresponsive to medical management. As heart failure progresses, reduced response to diuretics is common. Ultrafiltration in decompensated heart failure with cardiorenal syndrome article pdf available in new england journal of medicine 36724 november 2012 with 197 reads how we measure reads.
We undertook a metaanalysis to compare the effects of ultrafiltration and diuretics on major clinical outcomes. Role of isolated ultrafiltration in the management of chronic refractory and acute decompensated heart failure. Ultrafiltration should be the standard of care for patients with sodiumfluid overload admitted to the hospital with acute decompensated heart failure other promising therapies should prove safety and efficacy against the standard of ultrafiltration. Early ultrafiltration in patients with decompensated heart failure and diuretic resistance maria rosa costanzo, mitchell saltzberg, jeanne osullivan, paul sobotka ultrafiltration was used before intravenous diuretics in 20 patients with volume overload and diuretic resistance. Diuretics are the mainstay of therapy for restoring the euvolaemic state in patients with decompensated heart failure. In addition, adverse effects related to diuretic treatment are common, including worsening kidney function and electrolyte disturbances. Little is known about the efficacy and safety of ultrafiltration in patients with acute decompensated heart failure complicated by. The role of ultrafiltration in patients with decompensated.
Cardiorenal rescue study in acute decompensated heart. Acute decompensated heart failure adhf is a syndrome defined by worsening fatigue, dyspnea, or edema that results from deteriorating heart function and usually leads to hospital admission or unscheduled medical intervention. The negative prognostic impact of worsening renal function in patients with decompensated heart failure has been widely recognised. Backgroundheart failure patients with renal insufficiency and diuretic resistance have increased hospital mortality and length of stay.
Impact of ultrafiltration on serum sodium homeostasis and. Ultrafiltration is an alternative strategy to diuretic therapy for the treatment of patients with acute decompensated heart failure. The rapidchf relief for acutely fluidoverloaded patients with decompensated congestive heart failure study was the first randomized controlled trial to compare ultrafiltration and diuretic therapies in patients with adhf. Slow continuous ultrafiltration scuf uses a hydrostatic pressure difference p between the blood and nonblood sides of the membrane dotted line within the dialyzer to remove water and solutes from the plasma by ultrafiltration. Treatment of congestion in congestive heart failure. Ultrafiltration in the management of acute decompensated. Ultrafiltration for the management of acute decompensated heart failure. Pdf ultrafiltration in decompensated heart failure with. Extracorporeal ultrafiltration for fluid overload in heart. Efficacy and safety of ultrafiltration in decompensated heart failure patients with renal insufficiency. We conducted a retrospective cohort study to examine the efficacy and safety of ultrafiltration. As diuretics are thought to contribute to deterioration of kidney function in this setting, attempts have been made to either spare or suppress the diureticrelated pathophysiological mechanisms involved in this phenomenon. The study design and primary results of the carresshf trial cardiorenal rescue study in acute decompensated heart failure have been reported in detail.
Dialytic techniques used in decompensated heart failure. Despite diuretic therapy, many patients remain volume overloaded and symptomatic. Ultrafiltration for volume control in decompensated heart failure. In patients with acute decompensated heart failure adhf, treatment aimed at adequate decongestion of the volume overloaded state is essential. Ultrafiltration for the management of acute decompensated. Acute decompensated heart failure ultrafiltration system. All ultrafiltration devices for decompensated heart failure are considered. An example of an ultrafiltration device for decompensated heart failure is the aquadexflexflow system from chf solutions. Ultrafiltration versus intravenous diuretics for patients hospitalized for acute decompensated heart failure unload. The ultrafiltration versus intravenous diuretics for patients hospitalized for acute decompensated heart failure unload trial evaluated the safety and efficacy of early primary ultrafiltration. Pdf peritoneal ultrafiltration in patients with advanced. Ultrafiltration in decompensated heart failure request pdf. Cardiorenal implications of ultrafiltration and diuretics. Request pdf ultrafiltration in decompensated heart failure fluid congestion is the hallmark of decompensated heart failure.
We sought to determine if ultrafiltration before intravenous iv diuretics in patients with decompensated heart failure and diuretic resistance results in euvolemia and early discharge without hypotension or worsening renal function. Ultrafiltration in acute decompensated heart failure. The economic impact of ultrafiltration as an initial strategy for decompensated heart failure was also not addressed in this trial. Little is known about the efficacy and safety of ultrafiltration in patients with acute decompensated heart failure complicated by persistent congestion and worsened renal function. Ultrafiltration in decompensated heart failure with. Decongestive treatment of acute decompensated heart. Diuretics or ultrafiltration for acute decompensated heart. Ultrafiltration versus intravenous diuretics for patients hospitalized for acute decompensated heart failure. Ultrafiltration versus intravenous diuretics for patients. The therapeutic objective for these patients is volume and sodium. There are potential theoretical, but yet to be proven, advantages of ultrafiltration over loop diuretics for fluid removal in decompensated heart failure patients. Early ultrafiltration in patients with decompensated heart. Ultrafiltration for volume control in decompensated heart. We report our experience of using uf and evaluate its safety and impact on.
Chronic congestive heart failure chf and acute decompensated heart failure adhf refractory to medical therapy. Role of isolated ultrafiltration in the management of chronic refractory and acute decompensated heart failure mayank k. Ultrafiltration in patients with decompensated heart. Ultrafiltration for the treatment of congestive heart.
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