Ultrafiltration in the management of heart failure.
OBJECTIVE
Congestion causes the majority of hospitalizations for heart failure and contributes to heart failure progression and mortality. Intravenous loop diuretics reduce the signs and symptoms of congestion. Loop diuretics, however, may be associated with increased morbidity and mortality because of deleterious effects on neurohormonal activation, electrolyte balance, and cardiac and renal function. Ultrafiltration, an alternative method of sodium and water removal, safely improves hemodynamics in heart failure patients.


RESULTS
The Ultrafiltration versus Intravenous Diuretics for Patients Hospitalized for Acute Decompensated Heart Failure trial has recently shown that among 200 volume overloaded heart failure patients randomized to ultrafiltration or intravenous diuretics, 48 h weight (P = 0.001) and net fluid loss (P = 0.001) were greater in the ultrafiltration group. Dyspnea scores were similar. At 90 days, the ultrafiltration group had fewer heart failure rehospitalizations/patient (P = 0.022) and patients presenting for unscheduled visits (21 vs. 44%; P = 0.009). No serum creatinine differences occurred between the groups.


CONCLUSIONS
In decompensated heart failure, ultrafiltration safely produces greater weight and fluid loss than intravenous diuretics, reduces rehospitalization rates for heart failure and is an effective alternative therapy.
Costanzo
Maria Rosa
MR
Midwest Heart Foundation, Edward Heart Hospital, Naperville, Illinois 60566, USA. mcostanzo@midwestheart.com
D003422:Critical Care / Q000379:methods; D004232:Diuretics; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D014462:Ultrafiltration / Q000295:instrumentation / Q000592:standards
D004232:Diuretics