PMID- 20442667
OWN - NLM
STAT- MEDLINE
DCOM- 20101012
LR  - 20100630
IS  - 1558-2035 (Electronic)
IS  - 1558-2027 (Linking)
VI  - 11
IP  - 8
DP  - 2010 Aug
TI  - Ultrafiltration for the treatment of diuretic-resistant, recurrent, acute 
      decompensated heart failure: experience in a single center.
PG  - 599-604
LID - 10.2459/JCM.0b013e3283383275 [doi]
AB  - PURPOSE OF STUDY: We report our experience with ultrafiltration to remove fluid 
      overload in patients with diuretic-resistant, decompensated, congestive heart 
      failure. METHODS: From 2005 to 2008, 42 patients with heart failure and left 
      ventricular ejection fraction less than 40% were treated with ultrafiltration. 
      Patients were hospitalized for acute decompensation. Mean age was 69 years (67% 
      men). Cause of heart failure was ischemic in 52% of cases. New York Heart 
      Association (NYHA) class was III (64%) or IV (36%). All patients were on optimal 
      heart failure drugs. Average dose of furosemide before ultrafiltration was 250 
      mg. Exclusion criteria were contraindications to anticoagulants, hematocrit more 
      than 50%, glomerular filtration rate less than 30 ml/min and cardiogenic shock. 
      Ultrafiltration was performed using a venous femoral bilumen catheter and 
      anticoagulation with heparin. RESULTS: Each patient underwent one to four 
      ultrafiltration treatments (total 70). Mean duration of a treatment was 6 h. 
      Eighty-six percent of treatments removed more than 4000 ml of fluids; 10% removed 
      2000-4000 ml; 4% removed less than 2000 ml (1600-6900 ml). One ultrafiltration 
      was aborted because of persistent hypotension. Other complications include two 
      cases of bleeding from vascular access and six cases of worsened renal function. 
      One patients required dialysis. Six-month mortality after ultrafiltration was 
      26%. Hospitalization rate, 6 months after, was 30% (compared to 66% 6 months 
      before). Average furosemide dose, 6 months after, was 125 mg. CONCLUSION: 
      Ultrafiltration removed fluid overload in diuretic-resistant, severe, congestive 
      heart failure in our single-center experience. Six months after ultrafiltration, 
      hospitalization rates were reduced by 36% and furosemide dose was 50% lower, 
      compared to the previous 6 months. Worsened renal function was the most common 
      complication (14% of patients).
FAU - De Maria, Elia
AU  - De Maria E
AD  - Cardiology Unit, Ramazzini Hospital, Carpi, Modena, Italy. e.demaria@inwind.it
FAU - Pignatti, Foliero
AU  - Pignatti F
FAU - Patrizi, Giampiero
AU  - Patrizi G
FAU - Benenati, P Mario
AU  - Benenati PM
FAU - Ricci, Silvio
AU  - Ricci S
FAU - Cappelli, Stefano
AU  - Cappelli S
LA  - eng
PT  - Journal Article
PL  - United States
TA  - J Cardiovasc Med (Hagerstown)
JT  - Journal of cardiovascular medicine (Hagerstown, Md.)
JID - 101259752
RN  - 0 (Diuretics)
SB  - IM
MH  - Acute Disease
MH  - Aged
MH  - Aged, 80 and over
MH  - Catheterization, Peripheral
MH  - Diuretics/*therapeutic use
MH  - *Drug Resistance
MH  - Female
MH  - Femoral Vein
MH  - Heart Failure/drug therapy/mortality/physiopathology/*therapy
MH  - *Hemofiltration/adverse effects/mortality
MH  - Hospitalization
MH  - Humans
MH  - Italy
MH  - Kidney Diseases/etiology/physiopathology
MH  - Male
MH  - Middle Aged
MH  - Patient Readmission
MH  - Recurrence
MH  - Retrospective Studies
MH  - Severity of Illness Index
MH  - Stroke Volume
MH  - Time Factors
MH  - Treatment Failure
MH  - Ventricular Function, Left
MH  - *Water-Electrolyte Balance/drug effects
EDAT- 2010/05/06 06:00
MHDA- 2010/10/13 06:00
CRDT- 2010/05/06 06:00
PHST- 2010/05/06 06:00 [entrez]
PHST- 2010/05/06 06:00 [pubmed]
PHST- 2010/10/13 06:00 [medline]
AID - 10.2459/JCM.0b013e3283383275 [doi]
PST - ppublish
SO  - J Cardiovasc Med (Hagerstown). 2010 Aug;11(8):599-604. doi: 
      10.2459/JCM.0b013e3283383275.