A Randomized, Controlled Trial of the Renal Effects of Ultrafiltration as Compared to Furosemide in Patients With Acute Decompensated Heart Failure

Rogers, Hobart; Marshall, Joanne; Bock, Jeremy S.; Dowling, Thomas C.; Feller, Erika; Robinson, Shawn; Gottlieb, Stephen S.

doi:10.1016/j.cardfail.2007.09.007

Cited by 95 publications

(65 citation statements)

References 21 publications

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“…Effect of UF on renal function Three studies 21,22,24) reported creatinine values and there was no significant difference in the creatinine levels between the UF and control groups (WMD 0.05, 95% CI -0.23 to 0.33, P = 0.61, I2 = 77%, Figure 2C). Another 3 studies (4 publications) 19,20,23,25) reported that the changes in creatinine values were similar between the UF and control groups (WMD 0.05, 95% CI -0.15 to 0.26, P = 0.61, I2 = 77%, Figure 2D). …”

Section: Discussionmentioning

confidence: 88%

“…Thirteen articles were excluded (4 articles due to lack of renal function data, 8 articles were not RCTs, and 1 study was with normal renal function), and the remaining 8 articles [18][19][20][21][22][23][24][25] were analyzed. Among the 8 articles, two 19,25) reported the results of the UNLOAD trial by comparing the outcomes between UF and intravenous diuretics 19) and among UF, intravenous continuous or bolus diuretics 25) and the results from these two publications were summarized in this analysis.…”

Section: Studies and Patient Characteristicsmentioning

confidence: 99%

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Efficacy and Safety of Ultrafiltration in Decompensated Heart Failure Patients With Renal Insufficiency

Zhong

Wang

et al. 2015

Int. Heart J.

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SummaryUltrafiltration (UF) is an alternative strategy to diuretic therapy for the treatment of patients with decompensated heart failure. The impact of UF in decompensated heart failure with renal insufficiency remains unclear.A literature search was conducted for randomized controlled trials (RCTs) that investigated the use of UF in decompensated heart failure patients with renal insufficiency.Seven RCTs with 569 participants were eligible for analysis. There was significantly more 48 hour weight loss (WMD 1.59, 95% CI 0.32 to 2.86; P = 0.01; I2 = 68%) and 48 hour fluid removal (WMD 1.23, 95% CI 0.63 to 1.82; P < 0.0001; I2 = 43%) in the UF group compared to the control group. Serum creatinine (WMD 0.05; 95% CI -0.23 to 0.33; P = 0.61; I2 = 77%) and serum creatinine changes (WMD 0.05; 95% CI -0.15 to 0.26; P = 0.61; I2 = 77%) were similar between the UF and control groups. All-cause mortality (OR 0.95; 95% CI 0.58 to 1.55; P = 0.83; I2 = 0.0%) and all-cause rehospitalization (OR 0.97; 95% CI 0.49 to 1.92; P = 0.94; I2 = 52%) were also similar between the UF and control groups. Adverse events such as infection, anemia, hemorrhage, worsening heart failure, and other cardiac disorders did not differ significantly between the UF and control groups.UF is an effective and safe therapeutic strategy and produces greater weight loss and fluid removal without affecting renal function, mortality, or rehospitalization in patients with decompensated heart failure complicated by renal insufficiency. (Int Heart J 2015; 56: 319-323)

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Section: Discussionmentioning

confidence: 88%

Section: Studies and Patient Characteristicsmentioning

confidence: 99%

Efficacy and Safety of Ultrafiltration in Decompensated Heart Failure Patients With Renal Insufficiency

Zhong

Wang

et al. 2015

Int. Heart J.

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“…In a study by Rogers et al, the effect of ultrafiltration and diuretic treatments on glomerular filtration rate (GFR) and renal plasma flow was investigated. Forty-eight hours after the treatment, there were no significant differences in GFR and renal plasma flow between two groups despite a decrease in GFR in both groups (9). In a recent study by Hanna et al, cystatin C was used to evaluate renal function, and there were no significant differences in cystatin C levels 48 hours after the treatment (10).…”

Section: Türk Nefroloji Diyaliz Ve Transplantasyon Dergisi Turkish Nementioning

confidence: 95%

Comparison of Ultrafiltration and Intravenous Diuretic Therapies in Patients Hospitalized for Acute Decompensated Biventricular Heart Failure

Şeker¹,

Kayataş²,

Hüzmelí³

et al. 2016

Turk Neph Dial Transpl

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OBJECTIVE: Studies comparing ultrafiltration and diuretics in management of ADHF have shown controversial results. In this study, we compared the efficacy and safety of intravenous diuretic therapy and ultrafiltration in patients admitted with acute decompensated heart failure (ADHF) who had right ventricular dysfunction superimposed on left ventricular systolic dysfunction. MATERIAL and METHODs:A total of 30 patients of whom 10 were in the ultrafiltration group and 20 were in the diuretic group were enrolled in this study and followed for 3 months.REsULTs: At discharge, there were no significant differences between the ultrafiltration and diuretic groups in terms of weight loss , total fluid loss, and changes in serum creatinine. The clinical decongestion rates were similar in the two groups. Moreover, echocardiographic and biochemical parameters and alterations in renin and aldosterone levels, as measured to assess neurohormonal activation, had overlapping results between the two groups. When unwanted events were analyzed, transition to hemodialysis was seen in 20% of the patients in the ultrafiltration group and 5% of the patients in the diuretic group. The frequency of cardiac arrest and death were 40% in the ultrafiltration group and 10% in the diuretic group. Weight change, creatinine, and electrolyte levels of the patients at 1 and 3 months were also similar. CONCLUsION:Despite the high frequency of hemodialysis transition, cardiac arrest, and death in the ultrafiltration group, safety of ultrafiltration could not be assessed because of inability to perform statistical analyses. Further studies are needed to investigate the practical uses of ultrafiltration in routine clinical practice.

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“…Most studies showed either no change or even deterioration in renal function (25)(26)(27). Moreover, when iothalamate and para-aminohippurate clearance were used to precisely measure renal function, renal plasma flow, and filtration fraction during decongestion, the effect of UF on the kidney was found to be similar to that of diuretics (i.e., a slight decrease in GFR) (28).…”

Section: Renal Functionmentioning

confidence: 99%

Ultrafiltration Therapy for Heart Failure: Balancing Likely Benefits against Possible Risks

Kazory

2016

CJASN

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Heart failure remains a major public health concern because of its high prevalence, morbidity, mortality, and financial burden. The poor clinical outcomes associated with acute decompensated heart failure, suboptimal efficacy and safety profile of conventional treatment regimens, and unsatisfactory experiences with the newer classes of pharmacologic therapy underlie the interest in the use of extracorporeal isolated ultrafiltration in this setting. In this article, selected mechanistic aspects of ultrafiltration therapy are briefly reviewed followed by a critical overview of the largest trials in this field. I will discuss the clinical relevance of renal dysfunction and decongestion as two commonly used end points of safety and efficacy in the ultrafiltration trials, with emphasis on the emerging pertinent notions that could challenge our conventional thinking. Finally, a number of practical recommendations (e.g., customization of ultrafiltration rates) are provided for ultrafiltration therapy in the setting of acute decompensated heart failure. Because of a paucity of evidence, universally accepted consensus guidelines cannot yet be generated. As such, when considering ultrafiltration therapy for acute decompensated heart failure, the likely benefits should be carefully balanced against the potential risks for an individual patient. A conceivable implication of the ultrafiltration trials is that collaborative heart failure programs benefiting from nephrology expertise and resources could improve the outcomes and reduce the cost.

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A Randomized, Controlled Trial of the Renal Effects of Ultrafiltration as Compared to Furosemide in Patients With Acute Decompensated Heart Failure

Cited by 95 publications

References 21 publications

Efficacy and Safety of Ultrafiltration in Decompensated Heart Failure Patients With Renal Insufficiency

Efficacy and Safety of Ultrafiltration in Decompensated Heart Failure Patients With Renal Insufficiency

Comparison of Ultrafiltration and Intravenous Diuretic Therapies in Patients Hospitalized for Acute Decompensated Biventricular Heart Failure

Ultrafiltration Therapy for Heart Failure: Balancing Likely Benefits against Possible Risks

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