Is Aquapheresis ready for prime time yet for congestive heart failure? A systemic review of the literature

Abstract

AbstractHeart failure is a clinical syndrome with considerable morbidity and mortality rates. Recent data published by National Health and Nutrition Examination Survey (NHANES) showed that 6 million Americans are diagnosed with CHF. The prevalence of CHF is expected to increase by 46% from 2012 to 2030. The current therapy for acute CHF exacerbation involves the use of oral or intravenous diuretics. Aquapheresis is a form of slow continuous ultrafiltration where blood is removed by applying negative pressure by the machine, which is then passed through the unique filter across which a set fraction of plasma water is filtered each minute before it is pumped back into the patient. It is almost exclusively used in congestive heart failure patients who are found to be resistant to incremental doses of intravenous diuretics. Several trials have shown that aquapheresis or ultrafiltration (UF) produces more significant reductions in weight and may even decrease the rehospitalization rate within 90 days; however, a greater sample size is needed to obtain results of better statistical significance. Since UF does not improve survival in patients with heart failure, limiting factors to its use include cost, the need for a multidisciplinary team, catheter-related adverse events, and renal side effects. Guidelines need to be established for its use in heart failure.