Isolated ultrafiltration in moderate congestive heart failure

Agostoni, Piergiuseppe; Marenzi, Giancarlo; Pepi, Mauro; Doria, Elisabetta; Salvioni, Alessandro; Perego, Giovanni Battista; Lauri, G.; Giraldi, Francesco; Grazi, S; Guazzi, Maurizio D.

doi:10.1016/0735-1097(93)90685-t

Cited by 144 publications

(100 citation statements)

References 33 publications

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“…23,27-31 UF improves cardiac filling pressures, 28,29,[32][33][34][35] symptoms, exercise capacity, 32,33,36,37 and renal perfusion. 38 Serum sodium also improves…”

Section: Clinical Experience With Uf For Hfmentioning

confidence: 99%

Ultrafiltration for Congestive Heart Failure

Thorsgard¹,

Bart²

2009

Congestive Heart Failure

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Relief of congestive symptoms is a primary goal in treating heart failure. Ultrafiltration is a tool that can be used to safely remove sodium and water from whole blood at a controlled rate. Ultrafiltration decreases symptoms, relieves congestion, and improves hemodynamics, neurohormonal balance, and exercise capacity. This article describes the importance of congestion as a therapeutic target in heart failure and outlines the development of ultrafiltration as a treatment to address this important physiologic state.

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“…23,27-31 UF improves cardiac filling pressures, 28,29,[32][33][34][35] symptoms, exercise capacity, 32,33,36,37 and renal perfusion. 38 Serum sodium also improves…”

Section: Clinical Experience With Uf For Hfmentioning

confidence: 99%

Ultrafiltration for Congestive Heart Failure

Thorsgard¹,

Bart²

2009

Congestive Heart Failure

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“…UF therapy was initially explored in a series of interesting studies in Europe trying to elucidate its underlying mechanisms of action in the setting of ADHF, while simultaneously exploring its cardiorespiratory effects (11)(12)(13). Because exacerbation in neurohormonal activity is considered a key pathway in development, progression, and prognosis of HF, it was the focus of several UF studies.…”

Section: Mechanistic Considerationsmentioning

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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“…Compared with ongoing medical therapy, patients treated with ultrafiltration experienced improved hemodynamics, diastolic filling parameters, neurohormonal responsiveness, and exercise capacity. 34,36 A similar trial was subsequently performed with an active control arm by the same investigative team. Sixteen patients with mild heart failure were randomized to ultrafiltration (500 mL/hr) versus IV furosemide (IV bolus followed by continuous infusion-average dose 248 mg).…”

Section: Ultrafiltration Is the Preferred Initialmentioning

confidence: 99%

“…32 In contrast to the adverse physiological consequences of loop diuretics, numerous studies have demonstrated favorable responses to ultrafiltration. Such studies have shown that removal of [33][34][35][36][37][38][39][40][41][42][43][44][45][46] The evidence base supporting the use of ultrafiltration is superior to that for loop diuretics. There are 5 randomized controlled trials of ultrafiltration in patients with heart failure.…”

Section: Ultrafiltration Is the Preferred Initialmentioning

confidence: 99%