title: Continuous ultrafiltration for congestive heart failure: the CUORE trial.
abstract: Background: There are limited data comparing ultrafiltration with standard medical therapy as first-line treatment in patients with severe congestive heart failure (HF). We compared ultrafiltration and conventional therapy in patients hospitalized for HF and overt fluid overload.Methods and Results: Fifty-six patients with congestive HF were randomized to receive standard medical therapy (control group; n = 29) or ultrafiltration (ultrafiltration group; = 27). The primary endpoint of the study was rehospitalizations for congestive HF during a 1-year follow-up. Despite similar body weight reduction at hospital discharge in the 2 groups (7.5 ± 4.5 and 7.9 ± 5.0 kg, respectively;P = .75), a lower incidence of rehospitalizations for HF was observed in the ultrafiltration-treated patients during the following year (hazard ratio 0.14, 95% confidence interval 0.04-0.48; P = .002).Ultrafiltration-induced benefit was associated with a more stable renal function, unchanged furosemide dose, and lower B-type natriuretic peptide levels. At 1 year, 7 deaths (30%) occurred in the ultrafiltration group and 11 (44%) in the control group (P = .33).Conclusions: In HF patients with severe fluid overload, first-line treatment with ultrafiltration is associated with a prolonged clinical stabilization and a greater freedom from rehospitalization for congestive HF.
authors.affiliation: Centro Cardiologico Monzino, I.R.C.C.S., Milan, Italy. giancarlo.marenzi@ccfm.it
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Marenzi
authors.forename: Manuela
authors.initials: M
authors.lastname: Muratori
authors.forename: Eugenio R
authors.initials: ER
authors.lastname: Cosentino
authors.forename: Elisa R
authors.initials: ER
authors.lastname: Rinaldi
authors.forename: Valeria
authors.initials: V
authors.lastname: Donghi
authors.forename: Valentina
authors.initials: V
authors.lastname: Milazzo
authors.forename: Emiliana
authors.initials: E
authors.lastname: Ferramosca
authors.forename: Claudio
authors.initials: C
authors.lastname: Borghi
authors.forename: Antonio
authors.initials: A
authors.lastname: Santoro
authors.forename: Piergiuseppe
authors.initials: P
authors.lastname: Agostoni
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D006440:Hemofiltration / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D010359:Patient Readmission / Q000639:trends*; D011446:Prospective Studies; D014462:Ultrafiltration / Q000379:methods