title: Reduction in body weight but worsening renal function with late ultrafiltration for treatment of acute decompensated heart failure.
abstract: OBJECTIVE
  The safety, effectiveness and indications for ultrafiltration (UF) are not well established. We hypothesized that UF would not worsen renal function in patients with heart failure (HF) who were not responding to medical therapy.
  
  
  METHODS
  Data was collected for patients who underwent UF between 2006 and 2010 (n = 72, median age 61 years, 54% males, 61% Caucasian, 54% left ventricular ejection fraction ≥ 40%).
  
  
  RESULTS
  Baseline GFR was 38 ml/min/1.73 m2. All patients were initially treated with loop diuretics and 58% required a thiazide-like diuretic or vasoactive agent. UF resulted in total fluid removal of 11.3 liters and weight loss was 9.7 kg. The median decrease in eGFR during UF was 4.5 ml/min/m2 (IQR--13, 0; p < 0.01) and 43% of patients experienced a ≥ 20% decrease in eGFR. Ten percent of patients required dialysis and 13% died, received a ventricular assist device/cardiac transplant or were discharged to hospice.
  
  
  CONCLUSIONS
  In a cohort of HF patients who did not respond to medical therapy, UF was associated not only with a significant reduction of body weight and fluid removal, but also acute worsening of renal function. Further research to identify the appropriate population for UF, long-term outcomes and the intensity of treatment is required if UF is to gain wide acceptance for HF management.
authors.affiliation: Duke University Medical Center, Durham, NC, USA. sandesh.dev@va.gov
authors.forename: Sandesh
authors.initials: S
authors.lastname: Dev
authors.forename: Shailesh C
authors.initials: SC
authors.lastname: Shirolkar
authors.forename: Susanna R
authors.initials: SR
authors.lastname: Stevens
authors.forename: Linda K
authors.initials: LK
authors.lastname: Shaw
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Adams
authors.forename: G Michael
authors.initials: GM
authors.lastname: Felker
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Rogers
authors.forename: Christopher M
authors.initials: CM
authors.lastname: O'Connor
mesh_terms: D000208:Acute Disease; D000368:Aged; D059347:Cardio-Renal Syndrome / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006440:Hemofiltration / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D049994:Sodium Potassium Chloride Symporter Inhibitors / Q000627:therapeutic use; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology / Q000628:therapy; D018497:Ventricular Dysfunction, Right / Q000503:physiopathology / Q000628:therapy; D015431:Weight Loss / Q000502:physiology*
chemical_list: D049994:Sodium Potassium Chloride Symporter Inhibitors