The Role of Peripheral Ultrafiltration in the Management of Acute Decompensated Heart Failure

Abstract

Heart failure is a common and highly morbid condition associated with recurrent hospitalizations for disease decompensation. As such, heart failure is a growing public health concern from both a utilization and cost perspective. The current standard of care for the management of volume overload symptoms is underpinned by a diuretic-based treatment regimen. There is now increasing data to suggest that this approach may be counterproductive and result in progression of cardiac and renal disease with resultant higher mortality rates. Peripheral ultrafiltration is emerging as a viable, and in some cases preferred, option for sodium and fluid removal. Initial research trials have shown that this treatment modality results in improved clinical, biochemical and quality of life parameters. Moreover, these benefits are durable over the long term with decreased recidivism and health care utilization at 1 year. It remains unclear whether these benefits will translate into hard cardiovascular endpoints; greater adoption of this technology coupled with newer clinical trials will help researchers and clinicians identify the optimal strategy for treating symptoms of volume overload among heart failure patients.

Patients with high-dose diuretics should get ultrafiltration in the management of decompensated heart failure: a meta-analysis

“…Ultrafiltration as an alternative method is used to improve volume overload symptoms in all subsets of HF patients, including those with diuretic resistance or renal insufficiency [5–7]. The ability to precisely control the removal of sodium and water allows the ultrafiltrate extracted from serum during UF therapy to be isotonic.…”

The Therapy of Acute Decompensated Heart Failure Should Be Performed like a Work of Art

“…Besides the chronic complications, acute decompensated heart failure and a finding of volume overload may necessitate rapid treatment approaches [2]. Diuretics are a good choice of treatment and may be of benefit to certain patients under acute conditions, but if there are findings of excess fluid overload like respiratory distress, UF can be the only choice of treatment for a life-saving procedure [3,4,5]. A recent study by Bart et al [6 ]concluded that the use of an algorithm with steps of pharmacological therapy was superior to a strategy of UF for the protection of renal function on day 4 of treatment, and that UF was associated with higher rates of side effects.…”