Ultrafiltration versus usual care for hospitalized patients with heart failure: the Relief for Acutely Fluid-Overloaded Patients With Decompensated Congestive Heart Failure (RAPID-CHF) trial.
OBJECTIVE
The purpose of this research was to assess the safety and efficacy of ultrafiltration (UF) in patients admitted with decompensated congestive heart failure (CHF).


BACKGROUND
Ultrafiltration for CHF is usually reserved for patients with renal failure or those unresponsive to pharmacologic management. We performed a randomized trial of UF versus usual medical care using a simple UF device that does not require special monitoring or central intravenous access.


METHODS
Patients admitted for CHF with evidence of volume overload were randomized to a single, 8 h UF session in addition to usual care or usual care alone. The primary end point was weight loss 24 h after the time of enrollment.


RESULTS
Forty patients were enrolled (20 UF, 20 usual care). Ultrafiltration was successful in 18 of the 20 patients in the UF group. Fluid removal after 24 h was 4,650 ml and 2,838 ml in the UF and usual care groups, respectively (p = 0.001). Weight loss after 24 h, the primary end point, was 2.5 kg and 1.86 kg in the UF and usual care groups, respectively (p = 0.240). Patients tolerated UF well.


CONCLUSIONS
The early application of UF for patients with CHF was feasible, well-tolerated, and resulted in significant weight loss and fluid removal. A larger trial is underway to determine the relative efficacy of UF versus standard care in acute decompensated heart failure.
Bart
Bradley A
BA
Minnesota Heart Failure Consortium, Minneapolis, Minnesota, USA. bartx006@umn.edu
Boyle
Andrew
A
Bank
Alan J
AJ
Anand
Inder
I
Olivari
Maria Teresa
MT
Kraemer
Mark
M
Mackedanz
Shari
S
Sobotka
Paul A
PA
Schollmeyer
Mike
M
Goldsmith
Steven R
SR
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001794:Blood Pressure; D004232:Diuretics / Q000627:therapeutic use; D005240:Feasibility Studies; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006339:Heart Rate; D006440:Hemofiltration / Q000295:instrumentation; D006801:Humans; D008297:Male; D045283:Natriuretic Agents / Q000627:therapeutic use; D020097:Natriuretic Peptide, Brain / Q000627:therapeutic use; D015431:Weight Loss
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D004232:Diuretics; D045283:Natriuretic Agents; D020097:Natriuretic Peptide, Brain