Abstract
Heart failure is one of the leading causes of death in developed countries and remains a significant burden to the healthcare system. Fluid overload is a process responsible for the majority of the heart failure symptoms. Pharmacotherapy is a first-line treatment for this condition; however, due to the phenomenon of diuretic resistance, drug therapy can frequently be insufficient. Ultrafiltration is a promising but still understudied procedure that effectively targets the underlying pathophysiological mechanisms of congestion. The increased availability of simplified ultrafiltration devices, especially in intensive care units, prompted us to perform a current literature review on this treatment. In the present paper, we provide a concise review of the published trials on ultrafiltration, with a brief commentary on their conclusions and shortcomings. We also discuss the practical aspects of this treatment that remain unclear, such as the accurate selection of patients, choosing a suitable protocol for ultrafiltration, the proper time of initiation, monitoring of the therapy, and its desirable effects on renal function with further restoration of diuretic agent responsiveness.
Highlights
The ROSE-AHF trial examined the correlations between serum creatinine (sCr) and markers of tubular damage such as neutrophil gelatinase associated lipocalin (NGAL), N-acetyl-β-D-glucosaminidase (NAG) and kidney injury molecule-1 (KIM-1), and reported only low correlations.[47]
Ultrafiltration is a safe and effective method for decongestion in patients with acute decompensated heart failure (ADHF). The effectiveness of this therapy for removing fluid, reducing heart failure (HF) events and decreasing the number of subsequent hospitalizations has been demonstrated in a number of clinical trials
UF can serve as an alternative method for diuretic-resistant patients, without greater concern for a worsening of renal function
Summary
Such a rigid approach to UF without recalibrating the circuit to the clinical situation remains controversial.[30] A recent per-protocol analysis of the CARRESS-HF trial has shed additional light on the shortcomings of this study.[31] This protocol analysis revealed that UF group patients, who received their randomized treatment, had a significantly higher net fluid loss and reduction of weight.
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