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January 15, 2016Singapore Medical JournalOpen Access

Ultrafiltration in patients with decompensated heart failure and diuretic resistance: an Asian centre’s experience

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Why the study?

Does ultrafiltration improve fluid loss, weight loss, and clinical outcomes in patients with decompensated heart failure and diuretic resistance compared to standard intravenous diuretic therapy?

Population

44 hospitalized patients with a primary diagnosis of acute decompensated heart failure, diuretic resistance…

Comparison

Ultrafiltration using the Aquadex FlexFlow Fluid… vs Standard care with intravenous diuretics, with…

Design

Cohort

Follow-up

90 days

Authors

LTLY TeoCLCP LimSibu HospitalCNCL Neo

Discussion

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Implication

Ultrafiltration was associated with greater fluid removal in diuretic-resistant HF; hypothesis-generating and leaves open effects on outcomes pending RCTs.

Structured PICO

Does ultrafiltration improve fluid loss, weight loss, and clinical outcomes in patients with decompensated heart failure and diuretic resistance compared to standard intravenous diuretic therapy?

P
Population
44 hospitalized patients with a primary diagnosis of acute decompensated heart failure, diuretic resistance (urine output < 125 mL/hr after >=80 mg IV frusemide/day), and hypervolaemia. Median age 63.2 years, 84.1% male, Asian cohort (Singapore).
I
Intervention
Ultrafiltration (UF) using the Aquadex FlexFlow Fluid Removal System via central venous catheter, single course with fluid removal rate up to 500 mL/hr until euvolaemia achieved (n=18).
C
Comparator
Standard care with intravenous diuretics, with doses titrated by the treating physician to manage congestion (n=26).
O
Outcome
Net fluid loss and weight loss at 48 hours after treatment.surrogate

Ultrafiltration is an effective and safe alternative to standard diuretic therapy for achieving rapid fluid and weight loss in Asian patients with decompensated heart failure and diuretic resistance, leading to shorter hospital stays and fewer readmissions.

Limitations

  • Single-centre, retrospective cohort study with a small study population
  • Inherent biases as the use of inotropes and doses of intravenous diuretics were at the discretion of the treating physician for the standard care group, while UF was determined by a HF physician
  • Treating physician of the standard care group might have been a cardiologist of other subspecialties, whereas the treating physician of the UF group was a HF specialist

Cite This Study

Teo et al. (2016) studied this question.

synapsesocial.com/papers/6a7e1288fe8427622e9532d7https://doi.org/10.11622/smedj.2016014

Topics

Heart failureHFrEF treatmentHeart failure hospitalizationHFpEF management
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Ultrafiltration in the management of refractory congestive heart failure.1986 · 70 citations
  2. 2Correlates and impact on outcomes of worsening renal function in patients ≥65 years of age with heart failure2000 · 379 citations
  3. 3Trends and ethnic differences in hospital admissions and mortality for congestive heart failure in the elderly in Singapore, 1991 to 19982003 · 77 citations
  4. 4Ultrafiltration Versus Usual Care for Hospitalized Patients With Heart Failure2005 · 420 citations
  5. 5Diuretic response in acute heart failure: clinical characteristics and prognostic significance2014 · 367 citations