The role of peripheral ultrafiltration in the management of acute decompensated heart failure.
Heart failure is a common and highly morbid condition associated with recurrent hospitalizations for disease decompensation. As such, heart failure is a growing public health concern from both a utilization and cost perspective. The current standard of care for the management of volume overload symptoms is underpinned by a diuretic-based treatment regimen. There is now increasing data to suggest that this approach may be counterproductive and result in progression of cardiac and renal disease with resultant higher mortality rates. Peripheral ultrafiltration is emerging as a viable, and in some cases preferred, option for sodium and fluid removal. Initial research trials have shown that this treatment modality results in improved clinical, biochemical and quality of life parameters. Moreover, these benefits are durable over the long term with decreased recidivism and health care utilization at 1 year. It remains unclear whether these benefits will translate into hard cardiovascular endpoints; greater adoption of this technology coupled with newer clinical trials will help researchers and clinicians identify the optimal strategy for treating symptoms of volume overload among heart failure patients.
Andrade
Jason G
JG
Division of Cardiology, University of British Columbia, Vancouver, B.C., Canada.
Stadnick
Ellamae
E
Virani
Sean A
SA
D000208:Acute Disease; D002318:Cardiovascular Diseases / Q000139:chemically induced / Q000209:etiology; D018450:Disease Progression; D004232:Diuretics / Q000009:adverse effects / Q000627:therapeutic use; D004417:Dyspnea / Q000209:etiology / Q000517:prevention & control; D018495:Fluid Shifts; D006296:Health Services / Q000706:statistics & numerical data; D006333:Heart Failure / Q000209:etiology / Q000628:therapy*; D006440:Hemofiltration / Q000379:methods*; D006801:Humans; D007022:Hypotension / Q000139:chemically induced / Q000517:prevention & control; D007676:Kidney Failure, Chronic / Q000150:complications; D018377:Neurotransmitter Agents / Q000378:metabolism; D010865:Pilot Projects; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D006435:Renal Dialysis / Q000379:methods*; D055502:Secondary Prevention; D016896:Treatment Outcome; D014883:Water-Electrolyte Imbalance / Q000188:drug therapy / Q000209:etiology / Q000628:therapy
D004232:Diuretics; D018377:Neurotransmitter Agents