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López-Vilella R, Guerrero Cervera B, Sánchez-Lázaro I, Donoso Trenado V, Soldevila Orient A, Devesa Such R, Martínez Dolz L, Sánchez Pérez P, Almenar Bonet L. Therapeutic approach in heart failure with poor diuretic response: peripheral ultrafiltration vs. conventional treatment. ESC Heart Fail 2023. [PMID: 37144350 PMCID: PMC10375185 DOI: 10.1002/ehf2.14386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/30/2023] [Accepted: 04/03/2023] [Indexed: 05/06/2023] Open
Abstract
AIMS Patients with heart failure (HF) admitted for decompensation often require high doses of intravenous diuretics. This study aims to analyse whether the use of peripheral ultrafiltration (UF) in patients hospitalized for acute HF with systemic-predominant congestion results in better hydric control, renal protection, and reduction of hospital stay compared with conventional treatment. METHODS AND RESULTS This study was a retrospective, comparative, single-centre study of 56 patients admitted for HF with systemic congestion with a poor diuretic response after diuretic escalation. One group underwent peripheral UF (35 patients) and others were maintained on intense diuretic treatment (control group, 21 patients). The diuretic response and days of hospital stay were compared between and within groups. The baseline characteristics of both groups were similar: males with right ventricular failure and renal dysfunction. The inter-group analysis showed that patients who received UF had better glomerular filtration rate (GFR; UF: 39.2 ± 18.2 vs. control: 28.7 ± 13.4 mL/min; P = 0.031) and higher diuresis (UF: 2184 ± 735 vs. control: 1335 ± 297 mL; P = 0.0001) at hospital discharge despite less need for diuretic drugs. Days of hospital stay were shorter in the UF group (UF: 11.7 ± 10.1 vs. control: 19.1 ± 14.4 days; P = 0.027). Intra-group analysis showed that patients receiving UF improved GFR, increased diuresis, and reduced weight at discharge (P < 0.001), whereas patients on conventional treatment only experienced improved weight but worsening renal function at discharge. CONCLUSIONS In patients with acute HF with systemic congestion and diuretic resistance, UF compared with conventional treatment produces greater decongestion and renal protection, reduces the total diuretic load, and shortens the length of hospital stay.
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Affiliation(s)
- Raquel López-Vilella
- Heart Failure and Transplantation Unit, Hospital Universitari i Politècnic La Fe, Avenida Fernando Abril Martorell, 106, CP 46026, Valencia, Spain
- Department of Cardiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - Ignacio Sánchez-Lázaro
- Heart Failure and Transplantation Unit, Hospital Universitari i Politècnic La Fe, Avenida Fernando Abril Martorell, 106, CP 46026, Valencia, Spain
- Department of Cardiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Víctor Donoso Trenado
- Heart Failure and Transplantation Unit, Hospital Universitari i Politècnic La Fe, Avenida Fernando Abril Martorell, 106, CP 46026, Valencia, Spain
- Department of Cardiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Amparo Soldevila Orient
- Department of Nephrology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Kidney and Urinary Tract Area, Chronic Kidney Disease and Renal Replacement Therapy Section, Valencia, Spain
| | - Ramón Devesa Such
- Department of Nephrology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Kidney and Urinary Tract Area, Chronic Kidney Disease and Renal Replacement Therapy Section, Valencia, Spain
| | - Luis Martínez Dolz
- Department of Cardiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Pilar Sánchez Pérez
- Department of Nephrology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Kidney and Urinary Tract Area, Chronic Kidney Disease and Renal Replacement Therapy Section, Valencia, Spain
| | - Luis Almenar Bonet
- Heart Failure and Transplantation Unit, Hospital Universitari i Politècnic La Fe, Avenida Fernando Abril Martorell, 106, CP 46026, Valencia, Spain
- Department of Cardiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
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Abdo AS. Hospital Management of Acute Decompensated Heart Failure. Am J Med Sci 2016; 353:265-274. [PMID: 28262214 DOI: 10.1016/j.amjms.2016.08.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 07/26/2016] [Accepted: 08/02/2016] [Indexed: 12/13/2022]
Abstract
Heart failure (HF) is one of the leading causes of hospitalizations for elderly adults in the United States. One in 5 Americans will be >65 years of age by 2050. Because of the high prevalence of HF in this group, the number of Americans requiring hospitalization for this disorder is expected to rise significantly. We reviewed the most recent and ongoing studies and recommendations for the management of patients hospitalized due to decompensated HF. The Acute Decompensated Heart Failure National Registry, together with the 2013 American College of Cardiology Foundation and American Heart Association heart failure guidelines, earlier retrospective and prospective studies including the Diuretic Optimization Strategies Evaluation (DOSE), the Trial of Intensified vs Standard Medical Therapy in the Elderly Patients With Congestive Heart Failure (TIME-CHF), the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF), the Rapid Emergency Department Heart Failure Outpatient Trial (REDHOT) and the Comparison of Medical, Pacing and Defibrillation Therapies in Heart Failure (COMPANION) trial were reviewed for current practices pertaining to these patients. Gaps in our knowledge of optimal use of patient-specific information (biomarkers and comorbid conditions) still exist.
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Affiliation(s)
- Ashraf S Abdo
- Medical Service, GV (Sonny) Montgomery Veterans Affairs Medical Center, Jackson, Mississippi; University of Mississippi Medical Center, Jackson, Mississippi.
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