title: Ultrafiltration in decompensated heart failure with cardiorenal syndrome.
abstract: BACKGROUND
  Ultrafiltration is an alternative strategy to diuretic therapy for the treatment of patients with acute decompensated heart failure. Little is known about the efficacy and safety of ultrafiltration in patients with acute decompensated heart failure complicated by persistent congestion and worsened renal function.
  
  
  METHODS
  We randomly assigned a total of 188 patients with acute decompensated heart failure, worsened renal function, and persistent congestion to a strategy of stepped pharmacologic therapy (94 patients) or ultrafiltration (94 patients). The primary end point was the bivariate change from baseline in the serum creatinine level and body weight, as assessed 96 hours after random assignment. Patients were followed for 60 days.
  
  
  RESULTS
  Ultrafiltration was inferior to pharmacologic therapy with respect to the bivariate end point of the change in the serum creatinine level and body weight 96 hours after enrollment (P=0.003), owing primarily to an increase in the creatinine level in the ultrafiltration group. At 96 hours, the mean change in the creatinine level was -0.04±0.53 mg per deciliter (-3.5±46.9 μmol per liter) in the pharmacologic-therapy group, as compared with +0.23±0.70 mg per deciliter (20.3±61.9 μmol per liter) in the ultrafiltration group (P=0.003). There was no significant difference in weight loss 96 hours after enrollment between patients in the pharmacologic-therapy group and those in the ultrafiltration group (a loss of 5.5±5.1 kg [12.1±11.3 lb] and 5.7±3.9 kg [12.6±8.5 lb], respectively; P=0.58). A higher percentage of patients in the ultrafiltration group than in the pharmacologic-therapy group had a serious adverse event (72% vs. 57%, P=0.03).
  
  
  CONCLUSIONS
  In a randomized trial involving patients hospitalized for acute decompensated heart failure, worsened renal function, and persistent congestion, the use of a stepped pharmacologic-therapy algorithm was superior to a strategy of ultrafiltration for the preservation of renal function at 96 hours, with a similar amount of weight loss with the two approaches. Ultrafiltration was associated with a higher rate of adverse events. (Funded by the National Heart, Lung, and Blood Institute; ClinicalTrials.gov number, NCT00608491.).
authors.affiliation: Hennepin County Medical Center, Minneapolis, Minnesota, USA. bartx006@umn.edu
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Bart
authors.forename: Steven R
authors.initials: SR
authors.lastname: Goldsmith
authors.forename: Kerry L
authors.initials: KL
authors.lastname: Lee
authors.forename: Michael M
authors.initials: MM
authors.lastname: Givertz
authors.forename: Christopher M
authors.initials: CM
authors.lastname: O'Connor
authors.forename: David A
authors.initials: DA
authors.lastname: Bull
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Redfield
authors.forename: Anita
authors.initials: A
authors.lastname: Deswal
authors.forename: Jean L
authors.initials: JL
authors.lastname: Rouleau
authors.forename: Martin M
authors.initials: MM
authors.lastname: LeWinter
authors.forename: Elizabeth O
authors.initials: EO
authors.lastname: Ofili
authors.forename: Lynne W
authors.initials: LW
authors.lastname: Stevenson
authors.forename: Marc J
authors.initials: MJ
authors.lastname: Semigran
authors.forename: G Michael
authors.initials: GM
authors.lastname: Felker
authors.forename: Horng H
authors.initials: HH
authors.lastname: Chen
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Anstrom
authors.forename: Steven E
authors.initials: SE
authors.lastname: McNulty
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Velazquez
authors.forename: Jenny C
authors.initials: JC
authors.lastname: Ibarra
authors.forename: Alice M
authors.initials: AM
authors.lastname: Mascette
authors.forename: Eugene
authors.initials: E
authors.lastname: Braunwald
mesh_terms: D000368:Aged; D000465:Algorithms; D059347:Cardio-Renal Syndrome / Q000209:etiology / Q000628:therapy*; D003404:Creatinine / Q000097:blood; D004232:Diuretics / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D014462:Ultrafiltration / Q000009:adverse effects; D015431:Weight Loss / Q000187:drug effects
chemical_list: D004232:Diuretics; D003404:Creatinine