Therapeutic approach in heart failure with poor diuretic response: peripheral ultrafiltration vs. conventional treatment

Aims Patients with heart failure (HF) admitted for decompensation often require high doses of intravenous diuretics. This study aims to analyse whether the use of peripheral ultrafiltration (UF) in patients hospitalized for acute HF with systemic‐predominant congestion results in better hydric contr...

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Published in:ESC Heart Failure 2023-08, Vol.10 (4), p.2290-2297
Main Authors: López‐Vilella, Raquel, Guerrero Cervera, Borja, Sánchez‐Lázaro, Ignacio, Donoso Trenado, Víctor, Soldevila Orient, Amparo, Devesa Such, Ramón, Martínez Dolz, Luis, Sánchez Pérez, Pilar, Almenar Bonet, Luis
Format: Article
Language:English
Subjects:
Acute heart failure
Anticoagulants
Antigens
Cardiology
Cardiomyopathy
Chronic obstructive pulmonary disease
Congestion
Diabetes
Diuretics
Diuretics - therapeutic use
Drug dosages
Ejection fraction
Heart failure
Heart Failure - drug therapy
Hospital stay
Humans
Hydric control
Hypertension
Ischemia
Kidney
Male
Original
Patients
Peptides
Peripheral ultrafiltration
Renal protection
Retrospective Studies
Statistical analysis
Student's t-test
Ultrafiltration - methods
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Summary:Aims Patients with heart failure (HF) admitted for decompensation often require high doses of intravenous diuretics. This study aims to analyse whether the use of peripheral ultrafiltration (UF) in patients hospitalized for acute HF with systemic‐predominant congestion results in better hydric control, renal protection, and reduction of hospital stay compared with conventional treatment. Methods and results This study was a retrospective, comparative, single‐centre study of 56 patients admitted for HF with systemic congestion with a poor diuretic response after diuretic escalation. One group underwent peripheral UF (35 patients) and others were maintained on intense diuretic treatment (control group, 21 patients). The diuretic response and days of hospital stay were compared between and within groups. The baseline characteristics of both groups were similar: males with right ventricular failure and renal dysfunction. The inter‐group analysis showed that patients who received UF had better glomerular filtration rate (GFR; UF: 39.2 ± 18.2 vs. control: 28.7 ± 13.4 mL/min; P = 0.031) and higher diuresis (UF: 2184 ± 735 vs. control: 1335 ± 297 mL; P = 0.0001) at hospital discharge despite less need for diuretic drugs. Days of hospital stay were shorter in the UF group (UF: 11.7 ± 10.1 vs. control: 19.1 ± 14.4 days; P = 0.027). Intra‐group analysis showed that patients receiving UF improved GFR, increased diuresis, and reduced weight at discharge (P 
ISSN:2055-5822
2055-5822
DOI:10.1002/ehf2.14386