Ultrafiltration in decompensated CHF
Loop diuretics, have been the therapeutic icon for decades, however it may be associated with increased morbidity and mortality because of deleterious effects on neurohormonal activation, electrolyte balance, and cardiac and renal function. Ultrafiltration, an alternative method of sodium and water removal, safely improves hemodynamic in heart failure patients as reconfirmed again in a recently announced study 1.
Findings: Among 200 decompensated CHF patients randomized to ultrafiltration or intravenous diuretics,
- 48 hours weight (P = 0.001) and net fluid loss (P = 0.001) were greater in the ultrafiltration group. Dyspnea scores were similar.
- At 90 days, the ultrafiltration group had fewer heart failure rehospitalizations/patient (P = 0.022) and patients presenting for unscheduled visits (21 vs. 44%; P = 0.009).
- No serum creatinine differences occurred between the groups.
Conclusion: In decompensated CHF, ultrafiltration causes greater fluid and weight loss, as well as have a fewer rehospitalization rate and unscheduled visit.
Related previous pearl: The ‘UNLOAD’ Study
Reference: click to get abstract
Costanzo, MR. Ultrafiltration in the management of heart failure. Current Opinion in Critical Care. 14(5):524-530, October 2008.
