Clinical InvestigationUse of a Novel Ultrafiltration Device as a Treatment Strategy for Diuretic Resistant, Refractory Heart Failure: Initial Clinical Experience in a Single Center
Section snippets
Study Population
Soon after FDA approval of the System 100 for the treatment of HF, a collaborative clinical practice protocol was initiated by the cardiology and nephrology divisions at our institution to initiate UF with the System 100 device as a therapeutic option on our refractory HF service. This clinical practice protocol described an appropriate target population and recommended monitoring and was approved by the Mayo Cardiovascular Clinical Practice Committee in November of 2002. The nursing
Results
Two patients with suspected (5 and 6) and 9 patients with documented diuretic resistance were treated. Eight of the patients were directly admitted to the HF service while 3 were transferred from another hospital or service.
Table 2 outlines the baseline clinical, echocardiographic, and renal characteristics of the 11 patients. The mean duration of HF was 7 years (range 1–29). Nine patients (82%) had documented right ventricular dysfunction, 6 with severe tricuspid regurgitation, and 3 patients
Discussion
UF was hemodynamically well tolerated and unassociated with electrolyte derangements or major adverse complications although variability in the volume removed per treatment was significant. In this very-high-risk population, 45% of patients experienced an increase in creatinine of >.3 mg/dL during UF therapy. Pertinent features of our initial clinical experience are discussed below in the context of historical studies with conventional UF devices and contemporary studies with the System 100
Conclusion
Based on our initial clinical experience, we conclude that UF using the System 100 device directed by non-nephrologists can be safe and effective for short-term removal of fluid in very advanced HF patients who remain volume overloaded despite aggressive inpatient HF therapy. Limitations in volume removal experienced in our early experience may have been overcome with changes in device and catheter design, which have occurred since we used the device. We did observe a significant incidence of
Acknowledgment
The authors would like to thank Cindy Truex, RN for her help in data compilation.
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Cited by (63)
Ultrafiltration and other treatments of volume overload in congestive heart failure
2020, Emerging Technologies for Heart Diseases: Volume 1: Treatments for Heart Failure and Valvular DisordersManagement of Overhydration in Heart Failure Patients
2019, Critical Care Nephrology: Third EditionExtracorporeal Isolated Ultrafiltration for Management of Congestion in Heart Failure and Cardiorenal Syndrome
2018, Advances in Chronic Kidney DiseaseCitation Excerpt :On the other hand, a number of studies that used UF as a “rescue therapy” (ie, for patients who had failed aggressive, prolonged inpatient medical therapy) did not report positive results. For example, in a study by Liang and colleagues,32 UF was used as a rescue therapy in 11 patients who presented with diuretic resistance on average more than 4 days after receiving optimal medical management. Nearly half of the patients experienced worsening kidney function and 5 of them required dialysis on the same or subsequent admission.
Ultrafiltration for acute decompensated heart failure: A systematic review and meta-analysis of randomized controlled trials
2014, International Journal of CardiologyThe impact of ultrafiltration in acute decompensated heart failure: A systematic review and meta-analysis
2014, IJC Metabolic and EndocrineCitation Excerpt :The uncertainty over UF is reflected in a number of clinical guidelines. Previous studies evaluating UF for treatment of ADHF have mostly focused on intermediate endpoints (e.g., degree of volume removal, weight loss) and have shown mixed results [3,5]. Moreover, a benefit of UF on hard clinical endpoints (e.g., mortality, re-hospitalization) has not been consistently demonstrated.
Ultrafiltration therapy for acute decompensated heart failure: Lessons learned from 2 major trials
2013, American Heart Journal
Supported, in part, by grants from the Marriott Foundation, the Miami Heart Research Institute, and the Mayo-Dubai Healthcare City Research Program.