Key result
Early ultrafiltration in diuretic-resistant heart failure is linked to ~60% discharged within three days.
Why the study?
Heart failure patients with renal insufficiency and diuretic resistance have increased hospital mortality and length of stay. Whether peripheral veno-venous ultrafiltration before intravenous diuretics results in euvolemia and early discharge without hypotension or worsening renal function was evaluated.
Observational (n=20)
Answers are grounded in this paper and cite their sources.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“The removal of fluid was aggressive, with an average fluid removal of 8.6 ± 4.2 l and a mean decrease in weight of approximately 6 kg at discharge. As expected with the removal of fluid and solute, clinical signs and symptoms and laboratory indices of hypervolemia improved by discharge. The improvement lasted for up to 90 days after initiation of UF; however, loop diuretics use increased with admission and remained higher at all follow-up periods (not statistically different, given the small number of patients in this nonrandomized evaluation). Importantly, there was no apparent deterioration in parameters of renal function, hypotension, or hyperkalemia.”
Feasibility of early discharge supported in diuretic-resistant HF; hypothesis-generating and requires randomized confirmation before practice change.
Objectives We sought to determine if ultrafiltration before intravenous (IV) diuretics in patients with decompensated heart failure and diuretic resistance results in euvolemia and early discharge without hypotension or worsening renal function. Background Heart failure patients with renal insufficiency and diuretic resistance have increased hospital mortality and length of stay. Peripheral veno-venous ultrafiltration may re-establish euvolemia and diuretic responsiveness. Methods Ultrafiltration was initiated within 4.7 +/- 3.5 h of hospitalization and before IV diuretics in 20 heart failure patients with volume overload and diuretic resistance (age 74.5 +/- 8.2 years; 75% ischemic disease; ejection fraction 31 +/- 15%) and continued until euvolemia. Re-evaluation was each hospital day, at 30 days, and at 90 days. Results A total of 8,654 +/- 4,205 ml were removed with ultrafiltration. Twelve patients (60%) were discharged in < or =3 days. One patient was readmitted in 30 days. Weight (p = 0.006), Minnesota Living with Heart Failure scores (p = 0.003), and Global Assessment (p = 0.00003) improved after ultrafiltration and at 30 and 90 days. Median B-type natriuretic peptide levels decreased after ultrafiltration (from 1,230 pg/ml to 788 pg/ml) and at 30 days (815 pg/ml) (p = 0.035). Blood pressure, renal function, and medications were unchanged. Conclusions In heart failure patients with volume overload and diuretic resistance, ultrafiltration before IV diuretics effectively and safely decreases length of stay and readmissions. Clinical benefits persist at three months.
No takes yet. Share an insight, caveat, or question.
Costanzo et al. (2005) conducted an observational in Decompensated heart failure with volume overload and diuretic resistance (n=20). Early peripheral veno-venous ultrafiltration before intravenous diuretics was evaluated on Hospital discharge in <=3 days. Early ultrafiltration before IV diuretics in diuretic-resistant heart failure removed 8,654 ml of fluid, allowing 60% discharge in <=3 days and improving weight (p=0.006).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: