ULTRAFILTRATION IN THE TREATMENT OF VOLUME OVERLOAD DUE TO HEART FAILURE


Uri Elkayam, M.D., University of Southern California, Keck School of Medicine, Los Angeles, CA, USA

Volume overload leading to both hemodynamic and symptomatic congestion is the cause for hospitalizations in the majority of cases with heart failure (HF). Ultrafiltration (UF) has been traditionally used for removal of volume in patients with diuretics resistance and those who need removal of a large volume. Early European studies showed a rapid and controlled removal of fluid with UF with less neurohormonal activation compared to diuretics, restoration of diuretic responsiveness and improvement in exercise capacity. Two small studies in the US later demonstrated that early application of UF for patients with CHF was possible, well tolerated and resulted in a significant weight loss and shortening length of stay. These studies were followed by two larger studies, the first was the UNLOAD study which randomized 200 patients with hospitalized for HF to UF or diuretics. The study showed that effective removal of fluid with UF resulted in improved long term outcome with reduction of rehospitalizations and emergency room visits in 90 days. More recently the CARRESS study confirmed the ability for effective removal of fluid in patients with HF. Although UF was associated with an increase of serum creatinine this was not associated with an impact on outcome. This finding has confirmed results of a number of recent reports indicating that increased serum creatinine during successful management of volume overload and congestion is not associated with worsening of renal function and do not have an unfavorable effect on either short or long term outcome.