Key result
Ultrafiltration increases fluid loss versus diuretics but raises serum creatinine and neurohormonal activation.
Why the study?
The benefit of mechanical ultrafiltration compared to aggressive pharmacological decongestion in acute decompensated heart failure remains inconclusive.
Does mechanical ultrafiltration improve fluid loss, renal function, and neurohormonal activation compared to aggressive pharmacological decongestion in patients with acute decompensated heart failure?
Population
188 patients with acute decompensated heart failure from the CARRESS-HF trial
Comparison
Mechanical ultrafiltration vs aggressive urine output-guided pharmacological decongestion
Design
Per-protocol analysis of a randomized controlled trial
Follow-up
Up to 96 hours for biomarkers, 60 days for clinical outcomes
Authors
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UF-associated greater decongestion came with creatinine rise and neurohormonal activation; leaves open net benefit of mechanical therapy in cardiorenal syndrome.
RCT (n=188)
randomized
Does mechanical ultrafiltration improve fluid loss, renal function, and neurohormonal activation compared to aggressive pharmacological decongestion in patients with acute decompensated heart failure?
p-value: p=0.003
In acute decompensated heart failure, ultrafiltration provides greater fluid removal than aggressive pharmacological decongestion but is associated with worsening renal function and increased neurohormonal activation.
Grodin et al. (2018) conducted an RCT in acute decompensated heart failure (n=188). Ultrafiltration vs. Pharmacological protocol for decongestion was evaluated on Cumulative fluid loss (p=0.003). Ultrafiltration was associated with higher cumulative fluid loss (P=0.003) than pharmacological therapy, but also caused a rise in serum creatinine and neurohormonal activation.
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