[Ultrafiltration and hemofiltration in the cardiology unit].
The utilization of renal replacement therapies in cardiac patients has received increasing attention in recent years. In fact, isolated ultrafiltration has been proposed in patients with heart failure as a means for rapidly relieving fluid overload while preserving renal function; moreover, periprocedural hemofiltration (HF) has been suggested for radiocontrast-induced nephropathy (RCIN) prophylaxis. As a matter of fact fluid overload, with the ensuing systemic and pulmonary congestion, remains a major problem in patients with heart failure, and diuretic resistance is not an uncommon feature in the more advanced stages of the syndrome. In the same way, RCIN is increasingly indicated as a major complication of the use of iodinated contrast media, accounting for a significant number of hospital-acquired acute kidney injury episodes; moreover, it is thought to be associated with short- and long-term adverse effects on patient prognosis and increased economic burden. This article is aimed at reviewing the background of renal replacement therapies in the clinical context of cardiology wards, with special regard to isolated ultrafiltration and HF, as well as the current evidence regarding the safety and efficacy of these procedures, and their economic impact. From a theoretical point of view, isolated ultrafiltration could have a number of potential heart- and kidney-related advantages if compared to standard therapy (mainly diuretics). However, currently available clinical evidence does not support these concepts for its widespread utilization. Thus, isolated ultrafiltration should be reserved for selected patients with advanced heart failure and diuretic resistance, as part of a more complex strategy devoted to the control of fluid retention. There is currently no sound evidence for routinely recommending periprocedural HF in coronary angiography procedures, even in patients at high risk for RCIN.
Fiaccadori
Enrico
E
Terapia Intensiva, Dipartimento di Clinica Medica, Nefrologia e Scienze della Prevenzione, Università degli Studi, Parma. enrico.fiaccadori@unipr.it
Parenti
Elisabetta
E
Regolisti
Giuseppe
G
Detrenis
Simona
S
Meschi
Michele
M
Caiazza
Alberto
A
Cabassi
Aderville
A
D058186:Acute Kidney Injury / Q000139:chemically induced / Q000628:therapy*; D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography / Q000009:adverse effects; D003325:Coronary Care Units; D006333:Heart Failure / Q000000981:diagnostic imaging*; D006440:Hemofiltration / Q000379:methods; D006801:Humans; D017410:Practice Guidelines as Topic; D016896:Treatment Outcome; D014462:Ultrafiltration / Q000009:adverse effects / Q000379:methods*
D003287:Contrast Media