Abstract
The epithet of acute decompensated heart failure (ADHF) is volume overload. ADHF is associated with a rising number of hospital admission for volume overload. Medication non-compliance, excessive salt intake, comorbidities, and/or disease progression can attribute to volume overload. Heart failure (HF) therapy has innovated during the past few decades, but diuretics have been the mainstay of treatment. Diuretics are vital even though these drugs stimulate the renin-angiotensin-aldosterone system (RAAS) and lead to adaptive responses like diuretic resistance, neurohormonal activation, and worsening renal function that may be inimical. There has been a thriving interest in cutting-edge strategies to manage volume overload in ADHF. The American College of Cardiology Foundation (ACCF) and the American Heart Association (AHA) guidelines advocate pharmacological and non-pharmacological interventions to treat volume overload in ADHF patients. Ultrafiltration (UF) is, therefore, an emerging stand-in therapy of interest for treating volume overload in ADHF patients. This review article epitomizes available clinical data on the use of diuretics and UF in ADHF patients and identifies challenges for each approach.
Highlights
BackgroundHeart failure (HF) is a complex clinical syndrome due to inability of the heart to adequately fill or eject blood [1]
Heart failure (HF) therapy has innovated during the past few decades, but diuretics have been the mainstay of treatment
The first clinical trial to evaluate the biohumoral and hemodynamic effect of UF compared to standard intravenous diuretic therapy in acute decompensated heart failure (ADHF) was The ULTRADISCO (Effects of ULTRAfiltration versus Diuretics on clinical, biohumoral and hemodynamic variables in patients with decompensated heart failure) study
Summary
HF is a complex clinical syndrome due to inability of the heart to adequately fill or eject blood [1]. The first randomized study that compared intravenous loop diuretics to UF in ADHF was known as RAPIDCHF (Relief for Acutely Fluid-Overloaded Patients with Decompensated Congestive Heart Failure) trial, compared the UF group to the usual diuretic care group. Costanzo et al demonstrated in their study the benefit of early UF in reducing congestion in ADHF with diuretic resistance [45] In their trial, 60% of highrisk ADHF patients were discharged in less than three days and UF was not associated with worsening of kidney function, electrolyte disturbances or any symptomatic low blood pressure. The first clinical trial to evaluate the biohumoral and hemodynamic effect of UF compared to standard intravenous diuretic therapy in ADHF was The ULTRADISCO (Effects of ULTRAfiltration versus Diuretics on clinical, biohumoral and hemodynamic variables in patients with decompensated heart failure) study. In the ULTRADISCO study, It was theorized that the mechanism underlying the improvement of contractility was induced by UF because of lowered cytokine levels [46]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
