Slow isolated ultrafiltration for the treatment of congestive heart failure

Abstract

Slow isolated ultrafiltration (UF) was used to remove excess water and sodium in refractory congestive heart failure (CHF) patients. Fifty-two patients (40 men, 12 women; age, 63.8 ± 10.2 years) presenting with CHF (class IV, New York Heart Association (NYHA)) were included in the study. Forty-one patients had normal renal function, and 11 patients had various degrees of renal failure before the episode of cardiac decompensation. Cardiac disease caused by ischemia, hypertension, or a combination was present in the majority of patients (n = 28). UF was performed in all cases via a venovenous modality using a double-pump module (blood and UF pumps) and using highly permeable membrane (AN69; Hospal, Lyon, France). The weight loss achieved by UF to restore dry weight was 9.2 ± 5.0 kg over 9.0 ± 10.5 days with satisfactory hemodynamic tolerances. Outcome of the 52 patients was as follows: 13 patients (nonresponders) died during the course of treatment; 24 patients (responders) had both cardiac and renal temporary improvement for a short or long duration period; 15 patients (partial responders) had cardiac improvement and renal degradation leading to long-term treatment (intermittent UF or dialysis). Interestingly, diuresis returned in 24 of 39 responder patients. In conclusion, isolated UF offers a simple and effective means of escape from the cardio-renal vicious circle in refractory CHF patients. UF must be considered as an integral tool for the modern treatment of CHF.