Abstract
BackgroundUltrafiltration decreases total body water and improves the alveolar to arterial oxygen gradient. The aims of the study were to investigate the efficacy and safety of early ultrafiltration in acute decompensated heart failure (ADHF) patients.Methods100 patients with ADHF within 24 h of admission were randomly assigned into early ultrafiltration (n = 40) or torasemide plus tolvaptan (n = 60) groups. The primary outcomes were weight loss and an increase in urine output on days 4 and 8 of treatment.ResultsPatients who received early ultrafiltration for 3 days achieved a greater weight loss (kg) (− 2.94 ± 3.76 vs − 0.64 ± 0.91, P < 0.001) and urine increase (mL) (198.00 ± 170.70 vs 61.77 ± 4.67, P < 0.001) than the torasemide plus tolvaptan group on day 4. From days 4 to 7, patients in the early ultrafiltration group received sequential therapy of torasemide and tolvaptan. Better control of volume was reflected in a greater weight loss (− 3.72 ± 3.81 vs − 1.34 ± 1.32, P < 0.001) and urine increase (373.80 ± 120.90 vs 79.5 ± 52.35, P < 0.001), greater reduction of B-type natriuretic peptide (BNP) (pg/mL) (− 1144 ± 1435 vs − 654.02 ± 889.65, P = 0.037), NYHA (New York Heart Association) functional class (− 1.45 ± 0.50 vs − 1.17 ± 0.62, P = 0.018), jugular venous pulse (JVP) score (points) (− 1.9 ± 1.13 vs − 0.78 ± 0.69, P < 0.001), inferior vena cava (IVC) diameter (mm) (− 15.35 ± 11.03 vs − 4.98 ± 6.00, P < 0.001) and an increase in the dyspnea score (points) (4.08 ± 3.44 vs 2.77 ± 2.03, P = 0.035) in the early ultrafiltration group on day 8. No significant differences were found in the readmission and mortality rates in the 2 patient groups at the 1-month and 3-month follow-ups. Both groups had a similar stable renal profile.ConclusionEarly ultrafiltration is superior to diuretics for volume overload treatment initiation of ADHF patients.Trial registration Chinese Clinical Trial Registry, ChiCTR2000030696, Registered 10 March 2020—Retrospectively registered, https://www.chictr.org.cn/showproj.aspx?proj=29099.
Highlights
Ultrafiltration decreases total body water and improves the alveolar to arterial oxygen gradient
Acute heart failure (AHF) is the main reason for hospitalization of patients who are ≥ 65 years old, of which 80–85% present with acute exacerbations of chronic HF, that is, acute decompensated heart failure (ADHF)
We found that early ultrafiltration resulted in more weight loss and a greater urine output in hypervolemic ADHF patients compared to the torasemide plus tolvaptan treated group
Summary
Ultrafiltration decreases total body water and improves the alveolar to arterial oxygen gradient. The aims of the study were to investigate the efficacy and safety of early ultrafiltration in acute decompensated heart failure (ADHF) patients. Acute heart failure (AHF) arises from a variety of causes. AHF is the main reason for hospitalization of patients who are ≥ 65 years old, of which 80–85% present with acute exacerbations of chronic HF, that is, acute decompensated heart failure (ADHF). Studies have shown that fluid retention is the main reason for hospitalization of ADHF patients [2, 3]. Despite the extensive use of diuretics, the prognosis for inpatients with HF is not encouraging: 2–22% die during acute hospitalization [8, 9], 44% are readmitted within 6 months [10], and 33% die within 1 year [11]. It is estimated that more than 20% of patients did not improve their symptoms after diuretic therapy, and diuretic resistance occurred in more than 30% of patients [13, 14]
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