PMID- 33054727 OWN - NLM STAT- MEDLINE DCOM- 20210201 LR - 20210201 IS - 1471-2261 (Electronic) IS - 1471-2261 (Linking) VI - 20 IP - 1 DP - 2020 Oct 14 TI - Efficacy and safety of early ultrafiltration in patients with acute decompensated heart failure with volume overload: a prospective, randomized, controlled clinical trial. PG - 447 LID - 10.1186/s12872-020-01733-5 [doi] LID - 447 AB - BACKGROUND: Ultrafiltration decreases total body water and improves the alveolar to arterial oxygen gradient. The aims of the study were to investigate the efficacy and safety of early ultrafiltration in acute decompensated heart failure (ADHF) patients. METHODS: 100 patients with ADHF within 24 h of admission were randomly assigned into early ultrafiltration (n = 40) or torasemide plus tolvaptan (n = 60) groups. The primary outcomes were weight loss and an increase in urine output on days 4 and 8 of treatment. RESULTS: Patients who received early ultrafiltration for 3 days achieved a greater weight loss (kg) (- 2.94 +/- 3.76 vs - 0.64 +/- 0.91, P < 0.001) and urine increase (mL) (198.00 +/- 170.70 vs 61.77 +/- 4.67, P < 0.001) than the torasemide plus tolvaptan group on day 4. From days 4 to 7, patients in the early ultrafiltration group received sequential therapy of torasemide and tolvaptan. Better control of volume was reflected in a greater weight loss (- 3.72 +/- 3.81 vs - 1.34 +/- 1.32, P < 0.001) and urine increase (373.80 +/- 120.90 vs 79.5 +/- 52.35, P < 0.001), greater reduction of B-type natriuretic peptide (BNP) (pg/mL) (- 1144 +/- 1435 vs - 654.02 +/- 889.65, P = 0.037), NYHA (New York Heart Association) functional class (- 1.45 +/- 0.50 vs - 1.17 +/- 0.62, P = 0.018), jugular venous pulse (JVP) score (points) (- 1.9 +/- 1.13 vs - 0.78 +/- 0.69, P < 0.001), inferior vena cava (IVC) diameter (mm) (- 15.35 +/- 11.03 vs - 4.98 +/- 6.00, P < 0.001) and an increase in the dyspnea score (points) (4.08 +/- 3.44 vs 2.77 +/- 2.03, P = 0.035) in the early ultrafiltration group on day 8. No significant differences were found in the readmission and mortality rates in the 2 patient groups at the 1-month and 3-month follow-ups. Both groups had a similar stable renal profile. CONCLUSION: Early ultrafiltration is superior to diuretics for volume overload treatment initiation of ADHF patients. Trial registration Chinese Clinical Trial Registry, ChiCTR2000030696, Registered 10 March 2020-Retrospectively registered, https://www.chictr.org.cn/showproj.aspx?proj=29099 . FAU - Hu, Jingyi AU - Hu J AD - Department of Critical Care Medicine (Specialty of Heart Failure), Tongren Hospital, Shanghai Jiaotong University School of Medicine, No. 1111 Xianxia Road, Shanghai, 200336, China. FAU - Wan, Qianli AU - Wan Q AD - Department of Critical Care Medicine (Specialty of Heart Failure), Tongren Hospital, Shanghai Jiaotong University School of Medicine, No. 1111 Xianxia Road, Shanghai, 200336, China. FAU - Zhang, Yue AU - Zhang Y AD - Department of Critical Care Medicine (Specialty of Heart Failure), Tongren Hospital, Shanghai Jiaotong University School of Medicine, No. 1111 Xianxia Road, Shanghai, 200336, China. FAU - Zhou, Jun AU - Zhou J AD - Department of Cardiology, Tongren Hospital, Shanghai Jiaotong University School of Medicine, No. 1111 Xianxia Road, Shanghai, 200336, China. FAU - Li, Miaomiao AU - Li M AD - Department of Critical Care Medicine (Specialty of Heart Failure), Tongren Hospital, Shanghai Jiaotong University School of Medicine, No. 1111 Xianxia Road, Shanghai, 200336, China. FAU - Jiang, Li AU - Jiang L AD - Department of Cardiology, Tongren Hospital, Shanghai Jiaotong University School of Medicine, No. 1111 Xianxia Road, Shanghai, 200336, China. jiangli@shtrhospital.com. FAU - Yuan, Fang AU - Yuan F AUID- ORCID: 0000-0001-5278-110X AD - Department of Critical Care Medicine (Specialty of Heart Failure), Tongren Hospital, Shanghai Jiaotong University School of Medicine, No. 1111 Xianxia Road, Shanghai, 200336, China. yfangBM@163.com. LA - eng GR - 20062002/Shanghai Changning District Health Commission, Specialty in Acute Heart Failure/International PT - Comparative Study PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't DEP - 20201014 PL - England TA - BMC Cardiovasc Disord JT - BMC cardiovascular disorders JID - 100968539 RN - 0 (Antidiuretic Hormone Receptor Antagonists) RN - 0 (Sodium Potassium Chloride Symporter Inhibitors) RN - 21G72T1950 (Tolvaptan) RN - W31X2H97FB (Torsemide) SB - IM MH - Acute Disease MH - Aged MH - Aged, 80 and over MH - Antidiuretic Hormone Receptor Antagonists/adverse effects/*therapeutic use MH - China MH - Female MH - Fluid Shifts/*drug effects MH - Heart Failure/diagnostic imaging/physiopathology/*therapy MH - Humans MH - Male MH - Middle Aged MH - Prospective Studies MH - Sodium Potassium Chloride Symporter Inhibitors/adverse effects/*therapeutic use MH - Time Factors MH - Tolvaptan/adverse effects/*therapeutic use MH - Torsemide/adverse effects/*therapeutic use MH - Treatment Outcome MH - *Ultrafiltration/adverse effects MH - Urination/drug effects MH - Weight Loss/drug effects PMC - PMC7556949 OTO - NOTNLM OT - Early ultrafiltration OT - Fluid overload OT - Heart failure OT - Loop diuretics OT - Sequential therapy COIS- The authors declare that they have no competing interests. EDAT- 2020/10/16 06:00 MHDA- 2021/02/02 06:00 PMCR- 2020/10/14 CRDT- 2020/10/15 17:09 PHST- 2020/04/24 00:00 [received] PHST- 2020/10/07 00:00 [accepted] PHST- 2020/10/15 17:09 [entrez] PHST- 2020/10/16 06:00 [pubmed] PHST- 2021/02/02 06:00 [medline] PHST- 2020/10/14 00:00 [pmc-release] AID - 10.1186/s12872-020-01733-5 [pii] AID - 1733 [pii] AID - 10.1186/s12872-020-01733-5 [doi] PST - epublish SO - BMC Cardiovasc Disord. 2020 Oct 14;20(1):447. doi: 10.1186/s12872-020-01733-5.