Ultrafiltration in Acute Heart Failure

Costanzo, María Rosa

doi:10.15420/cfr.2018.29.2

Cited by 23 publications

(20 citation statements)

References 65 publications

(129 reference statements)

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“… 56–58 Elevations of central venous pressure are rapidly transmitted to the renal veins, causing increased interstitial and tubular hydrostatic pressures, which decrease net glomerular filtration in both acute and chronic heart failure. 59 …”

Section: Discussionmentioning

confidence: 99%

“…[56][57][58] Elevations of central venous pressure are rapidly transmitted to the renal veins, causing increased interstitial and tubular hydrostatic pressures, which decrease net glomerular filtration in both acute and chronic heart failure. 59 The direct relationship between the venous congestion and the incidence of WRF is clearly shown in, 60 that reports an incremental risk in WRF with increasing categories of baseline CVP with 75% of subjects with a baseline CVP >24 mm Hg developing WRF.…”

Section: Vencom In Hepatic and Renal Dysfunctionmentioning

confidence: 99%

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A Novel Non-Invasive Device for the Assessment of Central Venous Pressure in Hospital, Office and Home

Marcelli¹,

Cercenelli²,

Bortolani³

et al. 2021

MDER

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Background Venous congestion can be quantified by central venous pressure (CVP) and its monitoring is crucial to understand and follow the hemodynamic status of patients with cardio-respiratory diseases. The standard technique for CVP measurement is invasive, requiring the insertion of a catheter into a jugular vein, with potential complications. On the other hand, the current non-invasive methods, mainly based on ultrasounds, remain operator-dependent and are unsuitable for use in the home environment. In this paper, we will introduce a novel, non-invasive device for the hospital, office and home assessment of CVP. Methods After describing the measurement concept, we will report a preliminary experimental study enrolling 5 voluntary healthy subjects to evaluate the VenCoM measurements’ repeatability, and the system’s capability in measuring small elicited venous pressure variations (2 mmHg), as well as an induced venous hypertension within a pathological range (12÷20 mmHg). Results The experimental measurements showed a repeatability of ±1mmHg. The VenCoM device was able to reliably detect the elicited venous pressure variations and the simulated congestive status. Discussion and Conclusion The proposed non-invasive VenCoM device is able to provide a fast and repeatable CVP estimate, having a wide spectrum of potential clinical applications, including the monitoring of venous congestion in heart failure patients and in subjects with renal and hepatic dysfunction, as well as pulmonary hypertension (PH) that can be extended to pneumonia COVID-19 patients even after recovery. The device needs to be tested further on a large sample size of both healthy and pathological subjects, to systematically validate its reliability and impact in clinical setting.

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Section: Discussionmentioning

confidence: 99%

Section: Vencom In Hepatic and Renal Dysfunctionmentioning

confidence: 99%

A Novel Non-Invasive Device for the Assessment of Central Venous Pressure in Hospital, Office and Home

Marcelli¹,

Cercenelli²,

Bortolani³

et al. 2021

MDER

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show abstract

“…90% of the 1 million hospitalizations due to HF in the USA and Europe annually. 1 The initial accumulation of fluid is usually asymptomatic. However, increased intravascular volume, manifested by elevated central venous pressure, induces congestion and impedes flow in the renal veins, causing a net decrease in glomerular filtration.…”

Section: The Pathophysiology Of Congestionmentioning

confidence: 99%

Ultrafiltration in acute heart failure: Current knowledge and fields for further research

Urban¹,

Błaziak²,

Biegus³

et al. 2021

Adv Clin Exp Med

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Heart failure is one of the leading causes of death in developed countries and remains a significant burden to the healthcare system. Fluid overload is a process responsible for the majority of the heart failure symptoms. Pharmacotherapy is a first-line treatment for this condition; however, due to the phenomenon of diuretic resistance, drug therapy can frequently be insufficient. Ultrafiltration is a promising but still understudied procedure that effectively targets the underlying pathophysiological mechanisms of congestion. The increased availability of simplified ultrafiltration devices, especially in intensive care units, prompted us to perform a current literature review on this treatment. In the present paper, we provide a concise review of the published trials on ultrafiltration, with a brief commentary on their conclusions and shortcomings. We also discuss the practical aspects of this treatment that remain unclear, such as the accurate selection of patients, choosing a suitable protocol for ultrafiltration, the proper time of initiation, monitoring of the therapy, and its desirable effects on renal function with further restoration of diuretic agent responsiveness.

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“…The author offers insights as to what future studies need to examine, emphasizing individualized aquapheresis therapy adjusted by patients' haemodynamic and renal profiles. Guided objectives, in terms of total volume of fluid removal, duration of UF and UF rate, need to be established and utilized for better clinical outcomes [Costanzo 2019].…”

Section: E634mentioning

confidence: 99%

“…Although the utilization of aquapheresis has been studied in patients with ADHF, the potential of this therapy has not been fully explored in other patients who require fluid removal. Additionally, with the development of the more portable and user-friendly devices that are dedicated to isolated UF, patients can now readily receive aquapheresis therapy [Jaski 2003;Kazory 2018;Costanzo 2019].…”

Section: Introductionmentioning

confidence: 99%

Aquapheresis: An Institutional Experience

Khine

Lam

Dholakia

et al. 2020

HSF

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Background: Aquapheresis (AQ) consists of the extracorporeal extraction of plasma water from the vascular space across a semipermeable membrane in response to a transmembrane pressure gradient. The primary utilization of AQ has been in the management of patients with diuretic resistant heart failure with a treatment goal directed to quickly eliminate the excess fluid and optimize volume status. This modality is similar to isolated ultrafiltration performed on those patients requiring dialysis, but utilizes a machine that is smaller and easier to initiate and operate compared with traditional dialysis equipment. Method: A retrospective study that describes the indications in which AQ was utilized at Lenox Hill Hospital. The patient list was generated by searching for the keyword “Aquaph” in our electronic health record (EHR) orders. Patients were categorized based on hospital location and indication of AQ therapy. Additional information includes duration of treatment (days), changes in creatinine (start of AQ to stop of AQ), and total volume removed. Results: The search generated 28 patients; five were excluded as AQ was not initiated. In the remaining 23 patients, the mean aquapheretic volume per day was 1954 mls, with no significant change in creatinine. Indications for AQ broke out into five main categories: cardiogenic shock including post cardiothoracic procedure (10 pts); anasarca (5 pts); ATN with volume overload (4 pts); ESKD with bridge ultrafiltration between hemodialysis treatments (2 pts); and post-op volume overload (2 pts). Conclusion: We found that aquapheresis can be utilized in situations other than diuretic resistant heart failure. Also to consider, is the ease in which this less complicated aquapheresis equipment can be operated compared to the more complex hemodialysis equipment.

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Ultrafiltration in Acute Heart Failure

Cited by 23 publications

References 65 publications

A Novel Non-Invasive Device for the Assessment of Central Venous Pressure in Hospital, Office and Home

A Novel Non-Invasive Device for the Assessment of Central Venous Pressure in Hospital, Office and Home

Ultrafiltration in acute heart failure: Current knowledge and fields for further research

Aquapheresis: An Institutional Experience

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