Efficacy and safety of early ultrafiltration in patients with acute decompensated heart failure with volume overload: a prospective, randomized, controlled clinical trial

Abstract

Background Ultrafiltration decreases total body water and improves the alveolar to arterial oxygen gradient. The aims of the study were to investigate the efficacy and safety of early ultrafiltration in acute decompensated heart failure (ADHF) patients. Methods 100 patients with ADHF within 24 h of admission were randomly assigned into early ultrafiltration (n = 40) or torasemide plus tolvaptan (n = 60) groups. The primary outcomes were weight loss and an increase in urine output on days 4 and 8 of treatment. Results Patients who received early ultrafiltration for 3 days achieved a greater weight loss (kg) (− 2.94 ± 3.76 vs − 0.64 ± 0.91, P < 0.001) and urine increase (mL) (198.00 ± 170.70 vs 61.77 ± 4.67, P < 0.001) than the torasemide plus tolvaptan group on day 4. From days 4 to 7, patients in the early ultrafiltration group received sequential therapy of torasemide and tolvaptan. Better control of volume was reflected in a greater weight loss (− 3.72 ± 3.81 vs − 1.34 ± 1.32, P < 0.001) and urine increase (373.80 ± 120.90 vs 79.5 ± 52.35, P < 0.001), greater reduction of B-type natriuretic peptide (BNP) (pg/mL) (− 1144 ± 1435 vs − 654.02 ± 889.65, P = 0.037), NYHA (New York Heart Association) functional class (− 1.45 ± 0.50 vs − 1.17 ± 0.62, P = 0.018), jugular venous pulse (JVP) score (points) (− 1.9 ± 1.13 vs − 0.78 ± 0.69, P < 0.001), inferior vena cava (IVC) diameter (mm) (− 15.35 ± 11.03 vs − 4.98 ± 6.00, P < 0.001) and an increase in the dyspnea score (points) (4.08 ± 3.44 vs 2.77 ± 2.03, P = 0.035) in the early ultrafiltration group on day 8. No significant differences were found in the readmission and mortality rates in the 2 patient groups at the 1-month and 3-month follow-ups. Both groups had a similar stable renal profile. Conclusion Early ultrafiltration is superior to diuretics for volume overload treatment initiation of ADHF patients. Trial registration Chinese Clinical Trial Registry, ChiCTR2000030696, Registered 10 March 2020—Retrospectively registered, https://www.chictr.org.cn/showproj.aspx?proj=29099.

Use of novel non‐invasive techniques and biomarkers to guide outpatient management of fluid overload and reduce hospital readmission: systematic review and meta‐analysis

“…The readmission event per month is presented in Table 5. The pooled odds of readmission from nine studies (Figure 2) [11][12][13][14][15][16][17][18][19] in 5362 patients was 0.64 (95% CI 0.44, 0.92, P = 0.02) with moderate heterogeneity (I 2 = 46.5). Three studies 13,14,16 reported the HR, one study reported the incidence rate ratio 21 for readmission, and all studies were adjusted for intervention (Supporting Information, Table S8).…”

“…The effects of intervention were slightly greater in older patients and in those with longer follow-up periods, but the differences observed between the groups were not statistically significant (P = 0.75 and 0.42, respectively; Figure 3). The effect of intervention was greater (P = 0.001) in patients who received AFMP before discharge 15,20,21 (OR = 0.43) compared with that in those who received AFMP during postdischarge follow-up [11][12][13][14][16][17][18][19]22 (OR = 0.78; Figure 3). The intervention seemed to provide benefit in both types of HF patients (reduced and preserved LVEF), but it was statistically significant only in patients with preserved LVEF ≥ 40% (OR = 0.65, P = 0.02, I 2 = 70%; Figure 4).…”

“…Patients who started ultrafiltration before recommended treatment achieved greater weight loss quicker and had better outcomes. 15 During post-discharge follow-up, patient education is fundamental and effective patient self-care is an important tool to guiding fluid management. In a case-control study, Rouse et al 22 demonstrated that the three main aspects of patient management (daily weight to monitor hypervolemia, fluid management by limiting sodium intake, and contact a health professional following increase in weight) can reduce emergency visits due to HF as well as all-cause office visits.…”

Neues zur Diagnostik und Therapie der Herzinsuffizienz

“…Wenn bei Patienten mit akuter Herzinsuffizienz trotz maximaler diuretischer Therapie keine suffiziente Diurese zu etablieren ist, ist meist der Beginn einer Ultrafiltration notwendig. Entsprechend einer chinesischen Studie mit 100 akut kardial dekompensierten Patienten, kommt dabei der frühzeitigen Nierenersatztherapie eine wesentliche Bedeutung zu [ 12 ]. Im randomisierten Vergleich war die frühe Ultrafiltrationsbehandlung innerhalb von 24 h nach Aufnahme gegenüber einer diuretischen Therapie mit Torasemid und Tolvaptan mit einer stärkeren Abnahme des BNP-Wertes und der NYHA-Klasse assoziiert.…”

“…Im randomisierten Vergleich war die frühe Ultrafiltrationsbehandlung innerhalb von 24 h nach Aufnahme gegenüber einer diuretischen Therapie mit Torasemid und Tolvaptan mit einer stärkeren Abnahme des BNP-Wertes und der NYHA-Klasse assoziiert. Es konnten jedoch keine Unterschiede hinsichtlich der Hospitalisierungs- und Mortalitätsraten nach 1 und 3 Monaten nachgewiesen werden [ 12 ].…”