Key result
Extracorporeal veno-venous ultrafiltration yields conflicting results as an adjunctive therapy for congestion in HF.
Why the study?
Intravenous loop diuretics for heart failure have limitations such as worsening renal function and diuretic resistance, while modern trials evaluating extracorporeal veno-venous ultrafiltration have yielded conflicting results.
Does extracorporeal veno-venous ultrafiltration improve congestion management in patients with acute heart failure and fluid overload?
Does extracorporeal veno-venous ultrafiltration improve congestion management in patients with acute heart failure and fluid overload?
Extracorporeal veno-venous ultrafiltration offers theoretical advantages for fluid removal in acute heart failure, but clinical trial evidence remains conflicting.
Answers are grounded in this paper and cite their sources.
Should not change practice for acute HF congestion; leaves open adjunctive role pending resolution of conflicting RCTs.
Hospitalization for congestive heart failure represents a growing burden for health care systems. Heart failure is characterized by extracellular fluid overload and loop diuretics have been for decades the cornerstone of therapy in these patients. However, extensive use of intra-venous diuretics is characterised by several limitations: risk of worsening renal function and electrolyte imbalance, symptomatic hypotension and development of diuretic resistance. Extracorporealveno-venous ultrafiltration (UF) represents an interesting adjunctive therapy to target congestion in patients with heart failure and fluid overload. UF consists of the mechanical removal of iso-tonic plasma water from the blood through a semipermeable membrane using a pressure gradient generated by a pump. Fluid removal through UF presents several advantages such as removal of higher amount of sodium, predictable effect, limited neuro-hormonal activation, and enhanced spontaneous diuresis and diuretic response. After twenty years of "early" studies, since 2000 some pilot studies and randomized clinical trials with modern devices have been carried out with somehow conflicting results, as discussed in this review. In addition, some practical aspects of UF are addressed.
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Somaschini et al. (2021) conducted a review in Acute heart failure with fluid overload. Extracorporeal veno-venous ultrafiltration vs. Intravenous diuretics was evaluated. Extracorporeal veno-venous ultrafiltration is an adjunctive therapy for congestion in heart failure, though randomized clinical trials have yielded conflicting results.
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