Therapeutic approach in heart failure with poor diuretic response: peripheral ultrafiltration vs. conventional treatment

Author:

López‐Vilella Raquel12,Guerrero Cervera Borja2,Sánchez‐Lázaro Ignacio123,Donoso Trenado Víctor12,Soldevila Orient Amparo45,Devesa Such Ramón45,Martínez Dolz Luis23,Sánchez Pérez Pilar45,Almenar Bonet Luis123

Affiliation:

1. Heart Failure and Transplantation Unit Hospital Universitari i Politècnic La Fe Avenida Fernando Abril Martorell, 106 CP 46026 Valencia Spain

2. Department of Cardiology Hospital Universitari i Politècnic La Fe Valencia Spain

3. Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV) Instituto de Salud Carlos III Madrid Spain

4. Department of Nephrology Hospital Universitari i Politècnic La Fe Valencia Spain

5. Kidney and Urinary Tract Area Chronic Kidney Disease and Renal Replacement Therapy Section Valencia Spain

Abstract

AbstractAimsPatients with heart failure (HF) admitted for decompensation often require high doses of intravenous diuretics. This study aims to analyse whether the use of peripheral ultrafiltration (UF) in patients hospitalized for acute HF with systemic‐predominant congestion results in better hydric control, renal protection, and reduction of hospital stay compared with conventional treatment.Methods and resultsThis study was a retrospective, comparative, single‐centre study of 56 patients admitted for HF with systemic congestion with a poor diuretic response after diuretic escalation. One group underwent peripheral UF (35 patients) and others were maintained on intense diuretic treatment (control group, 21 patients). The diuretic response and days of hospital stay were compared between and within groups. The baseline characteristics of both groups were similar: males with right ventricular failure and renal dysfunction. The inter‐group analysis showed that patients who received UF had better glomerular filtration rate (GFR; UF: 39.2 ± 18.2 vs. control: 28.7 ± 13.4 mL/min; P = 0.031) and higher diuresis (UF: 2184 ± 735 vs. control: 1335 ± 297 mL; P = 0.0001) at hospital discharge despite less need for diuretic drugs. Days of hospital stay were shorter in the UF group (UF: 11.7 ± 10.1 vs. control: 19.1 ± 14.4 days; P = 0.027). Intra‐group analysis showed that patients receiving UF improved GFR, increased diuresis, and reduced weight at discharge (P < 0.001), whereas patients on conventional treatment only experienced improved weight but worsening renal function at discharge.ConclusionsIn patients with acute HF with systemic congestion and diuretic resistance, UF compared with conventional treatment produces greater decongestion and renal protection, reduces the total diuretic load, and shortens the length of hospital stay.

Publisher

Wiley

Subject

Cardiology and Cardiovascular Medicine

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