Prognosis of severe congestive heart failure patients refractory to high-dose frosemide and treated with continuous hemodiafiltration

Abstract

Continuous hemodiafiltration (CHDF) is an effective alternative to treat congestive heart failure (CHF) with renal dysfunction by forcibly normalizing volume overload. In order to assess the efficacy of CHDF for patients with severe chronic CHF refractory to high-dose frosemide, we retrospectively analyzed the echocardiography and blood examination from 33 cases (total 29 patients) with severe CHF (New York Heart Association Class IV) who underwent CHDF during the past 5 years in our hospital. The cause of CHF was ischemic in 15 cases, valvular in 8, hypertensive in 6, and cardiomyopathy in 4. Seventeen cases showed improvement of NYHA Class IV to III and discharged (survival group), while the rest 16 cases could not discontinue CHDF and died in hospital (non-survival group). There was no significant difference between age, sex, and echocardiographic data. Only serum sodium level (sNa) showed significant difference (135 ± 4.5 mmol/l vs 12 ± 95.1 mmol/l, p < 0.05), and no patients of high total bilirubin level (T-Bil) more than 2 mg/dl could survive. The prognosis of severe chronic CHF patients was quite poor even with the use of CHDF, and the sNa and T-Bil level might provide a convenient indicator of efficacy of CHDF.