Ultrafiltration in Patients with Hypervolemia and Congestive Heart Failure

Abstract

Fluid overload may occur in patients with myocardial dysfunction and different clinical problems. Myocoardial dysfunction may be a consequence of heart dilatation with reduced contractility, ventricular stiffness with diastolic dysfunction or the consequence of myocardial injury or circulating myocardial depressant factors as seen in sepsis. In all cases, cardiac support can be achieved by the optimization of fluid balance, the reduction in organ edema and the restoration of desirable levels of pre- and afterload. Several reports have shown that myocardial elastance can improve after hemofiltration with restoration of adequate fluid balance. In such conditions, continuous extracorporeal therapy may result in remarkable cardiovascular stability with maintenance of hemodynamic parameters, including mean arterial pressure, heart rate and systemic vascular resistance. Such stability, which is achieved through the slow continuous ultrafiltration and continuous refilling of the intravascular volume from the interstitium, enables the stability of the circulating blood volume and the preservation of organ perfusion. This is also crucial for renal recovery during acute renal failure.

Importance of Whole-Body Bioimpedance Spectroscopy for the Management of Fluid Balance

“…His quality of life improved significantly, he regained his appetite and could recommence everyday activities. Together with the reduction in fluid status, the systolic blood pressure rose towards normal ranges, very similar to a congestive heart failure patient described by Ronco et al [25] .…”

Current and future role of ultrafiltration in CRS

“…Slow continuous ultrafiltration (SCUF) is a variety of continuous renal replacement therapy (CRRT) used to achieve safe and effective management of severe fluid overload when medical therapy results inadequate. SCUF has been used as an adjunctive therapy for heart failure patients, achieving improvement of cardiac filling pressures, without dangerous reductions in circulating blood volume [6]. When a more complex manipulation of body fluid composition is required, hemofiltration (CVVH) is utilized.…”

“…Because of the low ultrafiltration and blood flow rates required, relatively small surface area filters can be employed with reduced heparin doses to maintain circuit patency. Main purpose of treatment is to achieve volume control; therefore, no fluids are administered either as dialysate or replacement fluids [6]. Synthetic high-flux membranes are generally employed because of their excellent permeability and biocompatibility characteristics [6].…”

“…Main purpose of treatment is to achieve volume control; therefore, no fluids are administered either as dialysate or replacement fluids [6]. Synthetic high-flux membranes are generally employed because of their excellent permeability and biocompatibility characteristics [6]. In case, additional blood purification or electrolyte equilibration is required, hemofiltration can be used.…”

Ascites and Kidney Transplantation: Case Report and Critical Appraisal of the Literature

“…Ascites correlated with the onset of renal insufficiency and resolved with regular HD. Ultrafiltration has been successfully utilized for controlling overhydration and ascites in patients with congestive heart failure [9,10]. Of the four cases of ascites reported in the medical literature occurring in patients with renal allograft rejection, two expired after a cardiac arrest, raising the possibility that underlying unrecognized heart dysfunction might have been present [1] (Table 1).…”