title: Outcomes of volume-overloaded cardiovascular patients treated with ultrafiltration.
abstract: BACKGROUND
  Ultrafiltration (UF) can rapidly and predictably remove extracellular and intravascular fluid volume. To date, assessment of UF in patients with cardiovascular disease has been confined to short- and medium-term studies in patients with a principal diagnosis of acute heart failure.
  
  
  METHODS
  In-hospital and long-term outcomes were reviewed from consecutive patients with cardiovascular disorders and recognized pulmonary and systemic volume overload treated with a simplified UF system with the capability for peripheral venovenous access. Trained abstractors reviewed both paper and electronic medical records. Patients with a principal diagnosis of heart failure versus other primary hospital discharge diagnoses were identified according to International Classification of Diseases, 9th Revision standards by independent coders.
  
  
  RESULTS
  For a period of 43 months, 100 patients (76 male/24 female, 65 +/- 14.0 years of age, systolic dysfunction 64%) were treated with UF during 130 hospitalizations. Baseline systolic blood pressure was 119 +/- 23 mm Hg. Before UF, 53% were receiving intravenous vasoactive therapy. By using UF, 7.1 +/- 3.9 L of ultrafiltrate were removed during 2.0 +/- 1.2 treatments per hospitalization. Baseline creatinine was 1.8 +/- 0.8 and 1.9 +/- 1.2 (not significant) at discharge. Of the 15 in-hospital deaths, 14 occurred during the initial hospitalization. Left ventricular dysfunction was related to 13 (87%) of the 15 deaths; no deaths were related to UF use. In hospitalizations with a principal diagnosis of heart failure (n = 79), in-hospital mortality was 7.6% compared with an ADHERE risk tree estimated mortality of 7.5%. Multivariate logistic regression identified a trend for decreased systolic blood pressure to predict patient initial hospitalization mortality (P = .06). Kaplan-Meier survivals for all patients were 71% at 1 year and 67% at 2 years. Cox regression found decreased systolic blood pressure as a predictor of long-term mortality (P = .025). Total volume of ultrafiltrate removed, ejection fraction, history of coronary artery disease, creatinine clearance, gender, age, and principal diagnosis of heart failure were not significantly associated with long-term mortality.
  
  
  CONCLUSIONS
  This series extends the spectrum of patients previously reported to be treated with UF. Despite marked volume overload, UF-treated patients with a principal diagnosis of heart failure had inpatient outcomes similar to the ADHERE registry. UF should be considered for a broad range of patients who present with volume overload.
authors.affiliation: San Diego Cardiac Center, Sharp Memorial Hospital, San Diego, California 92123, USA.
authors.forename: Brian E
authors.initials: BE
authors.lastname: Jaski
authors.forename: Andrew
authors.initials: A
authors.lastname: Romeo
authors.forename: Bryan
authors.initials: B
authors.lastname: Ortiz
authors.forename: Peter M
authors.initials: PM
authors.lastname: Hoagland
authors.forename: Maureen
authors.initials: M
authors.lastname: Stone
authors.forename: Dale
authors.initials: D
authors.lastname: Glaser
authors.forename: Lorie
authors.initials: L
authors.lastname: Thomas
authors.forename: Cynthia
authors.initials: C
authors.lastname: Walsh
authors.forename: Sidney C
authors.initials: SC
authors.lastname: Smith
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D006440:Hemofiltration / Q000379:methods / Q000639:trends*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014462:Ultrafiltration / Q000379:methods / Q000639:trends