Abstract
Background: Fluid removal remains a fundamental goal in the treatment of congestive heart failure (CHF). Vacuum ultrafiltration, hemodialysis, or a combination of both was used in patients with severe CHF (NYHA class IV), severe edema, and insensitivity to pharmacological treatment with diuretics. Methods: The aim of the study was to remove the overload fluid in eighteen patients, 13 men and 5 women, aged 38 to 83, with a man age of 66 years with intractable congestive heart failure. All patients were hospitalized because of severe congestive heart failure and did not respond to treatment with intravenous administration of a high dose of diuretics and positive inotropic agents. They thus underwent vacuum ultrafiltration (1 to 27 sessions) while in 4 of them hemodialysis was also performed because of high serum creatinine levels (over 4 mg/dl). Subclavian catheters were used in all patients and arteriovenous fistula was later performed in 2, because of the need for long term treatment. The average fluid removed was 2 L per session and the total fluid removed ranged from 4 to 29 L. Results: Fourteen of the 18 patients (78%) showed significant improvement in their clinical status. Ten patients (56%) had a short term improvement but expired after 7 to 107 days of hospitalization. Four patients (22%) died after only one session of dialysis and 4 patients (22%) recovered after 8 to 23 dialysis sessions and were discharged from hospital. Conclusion: The majority of patients with severe chronic CHF which is intractable to conventional therapy including intravenous diuretics and inotropes improve by the use of ultrafiltration. However, a limited proportion of them survive to be discharged from the hospital.
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References
Cohn JN. The management of chronic heart failure. N Engl J Med 1996 Aug 15; 335(7): 490–498.
The SOLVD Investigators. Effects of Enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. N Engl J Med 1991; 325: 293–302.
Parker M, Bristow MR, Cohn JN et al. The effect of carvedilol on morbidity and mortality in patients with chronic heart failure. N Engl J Med 1996; 334: 1349–1355.
Silverstein ME, Ford CA, Lysaght MJ, Henderson LW. Treatment of severe fluid overload by ultrafiltration. N Engl J Med 1974; 291: 747–751.
Simpson IA, Rae AP, Simpson K et al. Ultrafiltration in the management of refractory congestive heart failure. Br Heart J 1986 Apr; 55(4): 344–347.
Rimondini A, Cipolla CM, Della Bella P et al. Hemofiltration as short-term treatment for refractory congestive heart failure. Am J Med 1987; 83: 43–48.
Cipolla CM, Grazi S, Rimondini A et al. Changes in circulating norepinephrine with hemofiltration in advanced congestive heart failure. Am J Cardiol 1990; 66: 987–994.
Gerhardt RE, Abdulla AM, Mach SJ, Hudson JB. Isolated ultrafiltration in the therapy of volume overload accompanying oliguric vascular shock states. Am Heart J 1979; 567–571.
Susini G, Zucchetti M, Bortone F et al. Isolated ultrafiltration in cardiogenic pulmonary edema. Crit Care Med 1990; 18(1): 14–17.
Kaplan AA. Ultrafiltration in the treatment of congestive heart failure. Heart Failure 1994; 10: 192–197.
Lauer A, Saccaggi A, Ronco C, Belledonne M, Glabman S, Bosch JP. Continuous arteriovenous hemofiltration in the critically ill patient. Ann Intern Med 1983; 99: 455–460.
Laine GA, Allen SJ, Katz J, Gabel JC, Drake RE. Effect of systemic venous pressure elevation on lymph flow and lung edema formation. J Appl Physiol 1986; 61: 1634–1638.
Charman NB, Turk GM, Hey DH. Effect of increased bronchial venous pressure on lung lymph flow. J Appl Physiol 1985; 59: 1249–1253.
Agostoni PG, Deffebach ME, Kirk W, Lakshminarayan S, Butler J. Upstream pressure for systemic to pulmonary flow from bronchial circulation in dogs. J Appl Physiol 1987; 63: 485–491.
Butler J. The Heart is in good hands. Circulation 1983; 67: 1163–1168.
Cohn JN, Levine TB, Olivari MT et al. Plasma norepinephrine as a guide to prognosis in patients with chronic congestive heart failure. N Engl J Med 1984; 311: 819–823.
Swartz RD. The use of peritoneal dialysis in special situations. Adv Perit Dial 1999; 15: 160–166.
Nakanishi K, Hirasawa H, Sugai T et al. Efficacy of continuous hemodiafiltration for patients with congestive heart failure. Blood Purif 2002; 20: 342–348.
Mehrotra R, Khanna R. Peritoneal ultrafiltration for chronic congestive heart failure: rationale, evidence and future. Cardiology 2001; 96: 177–182.
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Grapsa, E., Alexopoulos, G.P., Margari, Z. et al. Ultrafiltration in the treatment of severe congestive heart failure. Int Urol Nephrol 36, 269–272 (2004). https://doi.org/10.1023/B:UROL.0000034633.95171.64
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DOI: https://doi.org/10.1023/B:UROL.0000034633.95171.64