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CLINICAL RESEARCH: HEART FAILURE

Early Ultrafiltration in Patients With Decompensated Heart Failure and Diuretic Resistance

Maria Rosa Costanzo, MD, FACC^_*,_*, Mitchell Saltzberg, MD, FACC^_*, Jeanne O’Sullivan, RN^_* and Paul Sobotka, MD, FACC

^_* Midwest Heart Foundation, Lombard, Illinois
CHF Solutions, Brooklyn Park, Minnesota

Manuscript received February 18, 2005; revised manuscript received May 4, 2005, accepted May 10, 2005.

^_* Reprint requests and correspondence: Dr. Maria Rosa Costanzo, Edward Heart Hospital, 4th Floor, 801 South Washington, P.O. Box 3226, Naperville, Illinois 60657 (Email: mcostanzo{at}midwestheart.com).

Presented in part at the 2004 American Heart Association Scientific Sessions, New Orleans, Louisiana, November 7–10, 2004.

OBJECTIVES: We sought to determine if ultrafiltration before intravenous (IV) diuretics in patients with decompensated heart failure and diuretic resistance results in euvolemia and early discharge without hypotension or worsening renal function.

BACKGROUND: Heart failure patients with renal insufficiency and diuretic resistance have increased hospital mortality and length of stay. Peripheral veno-venous ultrafiltration may re-establish euvolemia and diuretic responsiveness.

METHODS: Ultrafiltration was initiated within 4.7 ± 3.5 h of hospitalization and before IV diuretics in 20 heart failure patients with volume overload and diuretic resistance (age 74.5 ± 8.2 years; 75% ischemic disease; ejection fraction 31 ± 15%) and continued until euvolemia. Re-evaluation was each hospital day, at 30 days, and at 90 days.

RESULTS: A total of 8,654 ± 4,205 ml were removed with ultrafiltration. Twelve patients (60%) were discharged in 3 days. One patient was readmitted in 30 days. Weight (p = 0.006), Minnesota Living with Heart Failure scores (p = 0.003), and Global Assessment (p = 0.00003) improved after ultrafiltration and at 30 and 90 days. Median B-type natriuretic peptide levels decreased after ultrafiltration (from 1,230 pg/ml to 788 pg/ml) and at 30 days (815 pg/ml) (p = 0.035). Blood pressure, renal function, and medications were unchanged.

CONCLUSIONS: In heart failure patients with volume overload and diuretic resistance, ultrafiltration before IV diuretics effectively and safely decreases length of stay and readmissions. Clinical benefits persist at three months.

Abbreviations and Acronyms   ADHERE = Acute Decompensated Heart Failure National Registry   ADHF = acute decompensated heart failure   BNP = B-type natriuretic peptide   CrCl = creatinine clearance   MLWHFQ = Minnesota Living With Heart Failure Questionnaire   SBP = systolic blood pressure   sCr = serum creatinine

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