Large Volume Ultrafiltration for Acute Decompensated Heart Failure Using Standard Peripheral Intravenous Catheters

Dahle, Thom G.; Blake, Donnevan; Ali, Syed Salman; Olinger, Chad C.; Bunte, Matthew C.; Boyle, Andrew

doi:10.1016/j.cardfail.2006.02.012

Cited by 29 publications

(2 citation statements)

References 8 publications

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“…Our findings contrast with the UNLOAD trial and three small observational studies [18,19,20] in which patients treated with UF had no decline in renal function; however, two other observational studies of UF [17,21] reported WRF (table 6). There are several possible explanations for these disparate findings.…”

Section: Discussioncontrasting

confidence: 56%

Reduction in Body Weight but Worsening Renal Function with Late Ultrafiltration for Treatment of Acute Decompensated Heart Failure

et al. 2012

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Objectives: The safety, effectiveness and indications for ultrafiltration (UF) are not well established. We hypothesized that UF would not worsen renal function in patients with heart failure (HF) who were not responding to medical therapy. Methods: Data was collected for patients who underwent UF between 2006 and 2010 (n = 72, median age 61 years, 54% males, 61% Caucasian, 54% left ventricular ejection fraction ≥40%). Results: Baseline GFR was 38 ml/min/ 1.73 m². All patients were initially treated with loop diuretics and 58% required a thiazide-like diuretic or vasoactive agent. UF resulted in total fluid removal of 11.3 liters and weight loss was 9.7 kg. The median decrease in eGFR during UF was 4.5 ml/min/m² (IQR –13, 0; p <0.01) and 43% of patients experienced a ≥20% decrease in eGFR. Ten percent of patients required dialysis and 13% died, received a ventricular assist device/cardiac transplant or were discharged to hospice. Conclusions: In a cohort of HF patients who did not respond to medical therapy, UF was associated not only with a significant reduction of body weight and fluid removal, but also acute worsening of renal function. Further research to identify the appropriate population for UF, long-term outcomes and the intensity of treatment is required if UF is to gain wide acceptance for HF management.

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Section: Discussioncontrasting

confidence: 56%

Reduction in Body Weight but Worsening Renal Function with Late Ultrafiltration for Treatment of Acute Decompensated Heart Failure

et al. 2012

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“…In addition, changes in JVP, the JVP score, NYHA functional class, IVC diameter and IVC-CI values before and after treatment in the early ultrafiltration group were significantly greater than in the intensive diuretic group, indicating that ultrafiltration therapy had significant effects in correcting the clinical symptoms of sodium concentrations and therefore water retention in ADHF and in improving volume responsiveness. Ultrafiltration removes water from the blood through the dialysis membrane by a convective transport mechanism, which reduces the effective blood volume and improves the systemic circulation [ 41 , 42 ].…”

Section: Discussionmentioning

confidence: 99%

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

Wan

Zhang

et al. 2020

BMC Cardiovasc Disord

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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.

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Ultrafiltration for Acute Decompensated Heart Failure: Cost, Reimbursement, and Financial Impact

Ross

Bellamy

Hawig

et al. 2011

Clinical Cardiology

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In addition to the proposed pathophysiologic mechanisms whereby ultrafiltration (UF) can be advantageous over diuretics in the treatment of heart failure, there can also be financial and resource-utilization reasons for pursuing this extracorporeal strategy. In those cases in which the clinical outcomes would be equivalent, however, the decision whether to pursue UF will depend greatly on the anticipated hospitalization length of stay (LOS), the patient population's payor mix, the needs and costs for high-acuity (eg, intensive care unit) care, and widely varying expenses for the equipment and disposable supplies. From a fiscal perspective, the financial viability of UF programs revolves around how improvements in LOS, resource utilization, and readmissions relate to the typical diagnosis-driven (eg, diagnosis-related group) reimbursement. We analyzed the impact of these various factors so as to better understand how the intensity (and expense) of pharmaceutical and extracorporeal therapies impacts a single admission, as well as to serve as the basis for developing strategies for optimizing long-term care.

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Large Volume Ultrafiltration for Acute Decompensated Heart Failure Using Standard Peripheral Intravenous Catheters

Cited by 29 publications

References 8 publications

Reduction in Body Weight but Worsening Renal Function with Late Ultrafiltration for Treatment of Acute Decompensated Heart Failure

Reduction in Body Weight but Worsening Renal Function with Late Ultrafiltration for Treatment of Acute Decompensated Heart Failure

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

Ultrafiltration for Acute Decompensated Heart Failure: Cost, Reimbursement, and Financial Impact

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