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• W2897855204 abstract "Acute decompensated heart failure has the highest rate of hospital readmission among all medical conditions and portends a significant financial burden on health care system. Congestion, the hallmark of acute decompensated heart failure, represents the primary reason for hospitalization and the driver of adverse outcomes in these patients. Although diuretic-based medical regimens remain the mainstay of management of acute decompensated heart failure, they often show suboptimal efficacy and safety profiles in this setting. Mechanical extraction of excess fluid through extracorporeal ultrafiltration therapy has been proposed as a mechanistically relevant option in this setting. The advent of simplified, portable, and user-friendly devices that are dedicated to ultrafiltration therapy for these patients has renewed the interest in this therapeutic modality. In this article, we provide a brief overview of the initial mechanistic studies followed by the key clinical findings of the most recent landmark trials. The shortcomings of these studies are discussed in detail because not only do they provide the appropriate context in which the results are to be interpreted, but more importantly they also highlight the existing knowledge gaps that need to be addressed in future studies. Finally, selected practical and conceptual considerations and controversies are reviewed with regard to evidence-based ultrafiltration therapy. Acute decompensated heart failure has the highest rate of hospital readmission among all medical conditions and portends a significant financial burden on health care system. Congestion, the hallmark of acute decompensated heart failure, represents the primary reason for hospitalization and the driver of adverse outcomes in these patients. Although diuretic-based medical regimens remain the mainstay of management of acute decompensated heart failure, they often show suboptimal efficacy and safety profiles in this setting. Mechanical extraction of excess fluid through extracorporeal ultrafiltration therapy has been proposed as a mechanistically relevant option in this setting. The advent of simplified, portable, and user-friendly devices that are dedicated to ultrafiltration therapy for these patients has renewed the interest in this therapeutic modality. In this article, we provide a brief overview of the initial mechanistic studies followed by the key clinical findings of the most recent landmark trials. The shortcomings of these studies are discussed in detail because not only do they provide the appropriate context in which the results are to be interpreted, but more importantly they also highlight the existing knowledge gaps that need to be addressed in future studies. Finally, selected practical and conceptual considerations and controversies are reviewed with regard to evidence-based ultrafiltration therapy. Clinical Summary•Isolated extracorporeal ultrafiltration (UF) has emerged as an alternative therapy for mechanical extraction of fluid in congested patients with acute heart failure.•UF is more efficient than diuretics in removal of excess fluid in patients with acute heart failure and cardiorenal syndrome.•A UF regimen that is customized to the clinical characteristics of the patient is more likely to be beneficial.•The impact of UF therapy on mortality and the long-term outcomes needs future studies. •Isolated extracorporeal ultrafiltration (UF) has emerged as an alternative therapy for mechanical extraction of fluid in congested patients with acute heart failure.•UF is more efficient than diuretics in removal of excess fluid in patients with acute heart failure and cardiorenal syndrome.•A UF regimen that is customized to the clinical characteristics of the patient is more likely to be beneficial.•The impact of UF therapy on mortality and the long-term outcomes needs future studies. Heart failure (HF) represents a major health care problem because of its high prevalence, morbidity, mortality, and significant financial burden on the health care system. The course of chronic HF is highlighted by episodes of exacerbation; acute decompensated heart failure (ADHF) remains the leading cause of hospital admission in older patients and has the highest 30-day rehospitalization rate among all medical conditions.1Jencks S.F. Williams M.V. Coleman E.A. Rehospitalizations among patients in the Medicare fee-for-service program.N Engl J Med. 2009; 360: 1418-1428Crossref PubMed Scopus (3882) Google Scholar The annual cost of the care for patients with HF is estimated to be 60 billion dollars in the United States, with the expenses related to the in-hospital care accounting for almost 70% of the total expenditure.2Rosamond W. Flegal K. Furie K. et al.American Heart Association Statistics Committee and Stroke Statistics Subcommittee: heart disease and stroke statistics.Circulation. 2008; 117: e25-e146Crossref PubMed Scopus (3025) Google Scholar, 3Fang J. Mensah G.A. Croft J.B. et al.Heart failure-related hospitalization in the U.S., 1979 to 2004.J Am Coll Cardiol. 2008; 52: 428-434Crossref PubMed Scopus (432) Google Scholar Congestion, the hallmark of ADHF, is the primary reason for hospitalization of these patients. As such, removal of excess fluid constitutes a major goal in the management of these patients. Intravenous diuretics have long been considered the mainstay of therapy for ADHF. Beside untoward effects such as diuretic resistance and variable dose-response rate, studies have shown suboptimal efficacy of conventional diuretic-based regimens for treatment of congestion in ADHF. Nearly 40% of the patients still have congestive symptoms at the time of discharge and nearly half of them lose little weight (ie, <5 lbs) or even gain weight during hospital stay.4Gheorghiade M. Filippatos G. Reassessing treatment of acute heart failure syndromes: the ADHERE Registry.Eur Heart J. 2005; 7: B13-B19Crossref Scopus (112) Google Scholar The efficacy and safety of a number of other pharmacologic agents (eg, endothelin receptor antagonists and adenosine-A1 receptor antagonists) have also been explored in clinical trials in the hope of replacing or complementing diuretics, albeit with suboptimal results.5Kazory A. Ross E.A. Emerging therapies for heart failure: renal mechanisms and effects.Heart Fail Rev. 2012; 17: 1-16Google Scholar Newer agents, combined neprilysin-angiotensin inhibitors, have been shown to reduce the hospitalization rate of patients with chronic HF, although they are not considered the therapy for ADHF.6McMurray J.J. Packer M. Desai A.S. et al.Angiotensin-neprilysin inhibition versus enalapril in heart failure.N Engl J Med. 2014; 371: 993-1004Crossref PubMed Scopus (3895) Google Scholar Mechanical extraction of fluid has been explored as an alternative therapeutic option for decongestion of patients presenting with ADHF and fluid overload (Fig 1). Extracorporeal isolated ultrafiltration (UF) is a form of renal replacement therapy in which hydrostatic pressure gradient prompts mechanical shift of fluid across a hemofilter resulting in removal of plasma water along with the solutes. This pump-driven technique of decongestion was initially used nearly 4 decades ago as a modification of the standard hemodialysis circuit.8Silverstein M.E. Ford C.A. Lysaght M.J. et al.Treatment of severe fluid overload by ultrafiltration.N Engl J Med. 1974; 291: 747-751Crossref PubMed Scopus (143) Google Scholar, 9Sharma A. Hermann D.D. Mehta R.L. Clinical benefit and approach of ultrafiltration in acute heart failure.Cardiology. 2001; 96: 144-154Crossref PubMed Scopus (46) Google Scholar In the 1980s and 1990s, its use rapidly expanded to include treatment of fluid overload in refractory congestive HF.9Sharma A. Hermann D.D. Mehta R.L. Clinical benefit and approach of ultrafiltration in acute heart failure.Cardiology. 2001; 96: 144-154Crossref PubMed Scopus (46) Google Scholar In a report by Simpson and colleagues,10Simpson I.A. Rae A.P. Simpson K. et al.Ultrafiltration in the management of refractory congestive heart failure.Br Heart J. 1986; 55: 344-347Crossref PubMed Scopus (61) Google Scholar UF was used in treatment of 9 patients with refractory HF. They could remove a mean of 12.7 L of fluid in 2.9 sessions per patient (with an average of 3.8 hours per session) and observed a sustained symptomatic improvement in all patients. Persistent increase in serum sodium concentration was also noted by the investigators. Later on, a series of interesting studies, mainly in Italy, were performed to elucidate UF's underlying mechanisms of action.11Kazory A. Cardiorenal syndrome: ultrafiltration therapy for heart failure—trials and tribulations.Clin J Am Soc Nephrol. 2013; 8: 1816-1828Crossref PubMed Scopus (32) Google Scholar These studies explored the hemodynamic and cardiorespiratory impacts of UF as well. Persistence of the beneficial effects beyond the duration of therapy is an intriguing finding of these studies. For example, in a randomized controlled trial (RCT) by Agostoni and colleagues,12Agostoni P.G. Marenzi G.C. Pepi M. et al.Isolated ultrafiltration in moderate congestive heart failure.J Am Coll Cardiol. 1993; 21: 424-431Crossref PubMed Scopus (135) Google Scholar 1 single session of UF was associated with a significant improvement in several respiratory parameters that lasted 6 months after the treatment. Contemporary large-scale trials (discussed subsequently) have also been reported on the sustainability of the benefits of UF. Selected proposed benefits of UF are summarized in Table 1. Although mechanical fluid removal is often achieved by dedicated UF devices or conventional hemodialysis machines, it has also been used in other settings for the critically ill patients such as during the use of extracorporeal membrane oxygenation for cardiogenic shock (via an in-line hemofilter or introduction of a continuous renal replacement therapy device into the extracorporeal membrane oxygenation circuit).13Keebler M.E. Haddad E.V. Choi C.W. et al.Venoarterial extracorporeal membrane oxygenation in cardiogenic shock.JACC Heart Fail. 2018; 6: 503-516Crossref PubMed Scopus (112) Google Scholar Excess fluid can also be extracted during hemofiltration with cardiopulmonary bypass for cardiac surgeries.14McRobb C.M. Mejak B.L. Ellis W.C. et al.Recent advances in pediatric cardiopulmonary bypass.Semin Cardiothorac Vasc Anesth. 2014; 18: 153-160Google Scholar These modalities of achieving UF are beyond the scope of this article as they have indications, protocols, and goals of therapy that are quite distinct from those described here.Table 1Proposed Advantages of Ultrafiltration for Heart Failure∗Adapted and republished with permission of the American Society of Nephrology, from Kazory11; permission conveyed through Copyright Clearance Center, Inc.Reduction in Renal Venous Congestion and Improvement in Renal HemodynamicsRapid and adjustable removal of fluid and improvement in symptoms of congestionHigher mass clearance of sodiumDecreased risk of electrolyte abnormalities (eg, hypokalemia)Lack of neurohormonal activation (SNS, RAAS, and AVP)Sustainability of the beneficial effects (eg, impact on neurohormonal axis)Improvement in diuretic resistance, natriuresis, and urine outputDecreased rate of heart failure–related rehospitalizationDecreased hospital length of stayAvailability of dedicated ultrafiltration devices that are portable, user-friendly, with minimal extracorporeal volume (33 mL), and have the ability of functioning with low blood flow rates (10-40 mL/min)Abbreviations: AVP, arginine vasopressin; RAAS, renin-angiotensin-aldosterone system; SNS, sympathetic nervous system.∗ Adapted and republished with permission of the American Society of Nephrology, from Kazory11Kazory A. Cardiorenal syndrome: ultrafiltration therapy for heart failure—trials and tribulations.Clin J Am Soc Nephrol. 2013; 8: 1816-1828Crossref PubMed Scopus (32) Google Scholar; permission conveyed through Copyright Clearance Center, Inc. Open table in a new tab Abbreviations: AVP, arginine vasopressin; RAAS, renin-angiotensin-aldosterone system; SNS, sympathetic nervous system. The overall positive results of the early feasibility and mechanistic studies established UF as a mechanistically relevant therapeutic option for patients with refractory HF and fluid overload. However, lack of large-scale controlled trials and the relative complexity of this modality hindered its widespread use. In the early 2000, there was a renewed interest in this therapy partly because of the advent of the user-friendly portable devices that are dedicated to UF. These user-friendly machines have the advantages of portability, low blood flow rates (40 mL/min), and a small extracorporeal blood volume (<50 mL). They can provide UF rate within a large spectrum (0-500 mL/h) and do not mandate admission to higher levels of care (eg, intensive care unit). A series of larger studies and RCTs were thereafter published that formed the foundation for our current understanding of the efficacy and safety of UF therapy in the setting of ADHF. The details of these studies have been previously reviewed elsewhere7Kazory A. Ultrafiltration therapy for heart failure: balancing likely benefits against possible risks.Clin J Am Soc Nephrol. 2016; 11: 1463-1471Google Scholar; herein, we briefly discuss the 3 largest RCTs. The Ultrafiltration Versus Intravenous Diuretics for Patients Hospitalized for Acute Decompensated Heart Failure (UNLOAD) trial is the first landmark study in this field.15Costanzo M.R. Guglin M.E. Saltzberg M.T. et al.Ultrafiltration versus intravenous diuretics for patients hospitalized for acute decompensated heart failure.J Am Coll Cardiol. 2007; 49: 675-683Crossref PubMed Scopus (840) Google Scholar It compared slow continuous UF with a conventional diuretic-based regimen in 200 patients with ADHF. Patients randomized to the standard-care arm were treated with intravenous diuretics (average daily dose 181 mg/d referenced to furosemide-equivalent doses). All diuretics were stopped in the UF arm and patients received UF therapy at fluid removal rates of up to 500 mL/h. At 48 hours, weight (5.0 vs 3.1 kg; P = .001) and net fluid loss (4.6 vs 3.3 L; P = .001) were significantly greater in the UF group, without an apparent adverse impact on kidney function or blood pressure. Of special note, the UF group also demonstrated a greater freedom from rehospitalization during the 90-day follow-up period. Moreover, rehospitalization days and HF-related unscheduled visits were fewer for these patients, and UF was associated with a 53% reduction in the risk of rehospitalization for ADHF. The findings of the UNLOAD trial were a breakthrough that further promoted UF use; there were even suggestions for its use as the first-line therapy for ADHF before diuretic has been tried.16Bart B.A. Treatment of congestion in congestive heart failure: ultrafiltration is the only rational initial treatment of volume overload in decompensated heart failure.Circ Heart Fail. 2009; 2: 499-504Crossref Scopus (65) Google Scholar The second largest RCT in this field, the Cardiorenal Rescue Study in Acute Decompensated Heart Failure (CARRESS-HF) was published in 2012.17Bart B.A. Goldsmith S.R. Lee K.L. et al.Ultrafiltration in decompensated heart failure with cardiorenal syndrome.N Engl J Med. 2012; 367: 2296-2304Crossref PubMed Scopus (635) Google Scholar In this National Institutes of Health–sponsored study, patients with ADHF and persistent congestion who also presented with worsening kidney function were randomized to receive either an algorithm-based stepped pharmacologic regimen or UF. Surprisingly, UF was found to be inferior to pharmacologic treatment, mainly because of deterioration in kidney function (0.23 mg/dL increase in serum creatinine for UF vs 0.04 mg/dL decrease for medical therapy; P = .003) despite similar weight loss (5.7 kg for UF vs 5.5 kg for medical therapy; P = .58). Indeed, because of a lack of evidence of benefit for UF and an excess of adverse events, the enrollment had to be ended after the first 188 patients were included. Interestingly, the investigators did not observe a significant difference in the mortality or rehospitalization rate between the 2 groups despite the increase in serum creatinine in the UF arm. This is in line with the findings of more recent studies highlighting the interdependence of congestion and the changes in kidney function.18Kazory A. Elkayam U. Cardiorenal interactions in acute decompensated heart failure: contemporary concepts facing emerging controversies.J Card Fail. 2014; 20: 1004-1011Abstract Full Text Full Text PDF Scopus (29) Google Scholar Recently, the “per-protocol” analysis of the CARRESS-HF trial revealed that, in contrast to the initial published results, UF did in fact lead to more efficient decongestion as evidenced by higher cumulative fluid loss (P = .003), net fluid loss (P = .001), and relative reduction in weight (P = .02) compared with pharmacologic therapy.19Grodin J.L. Carter S. Bart B.A. et al.Direct comparison of ultrafiltration to pharmacological decongestion in heart failure: a per-protocol analysis of CARRESS-HF.Eur J Heart Fail. 2018; 20: 1148-1156Google Scholar Nevertheless, it has been suggested that the therapy in both groups was prematurely terminated leaving patients with unresolved congestion.20Costanzo M.R. Kazory A. Better late than never: the true results of CARRESS-HF.Eur J Heart Fail. 2018; 20: 1157-1159Google Scholar Worsening kidney function might be a misnomer in the field of HF; several studies have shown that a transient increase in serum creatinine during the therapy of ADHF could paradoxically be associated with improved outcomes (ie, indicative of effective decongestion).18Kazory A. Elkayam U. Cardiorenal interactions in acute decompensated heart failure: contemporary concepts facing emerging controversies.J Card Fail. 2014; 20: 1004-1011Abstract Full Text Full Text PDF Scopus (29) Google Scholar A recent analysis from the low-dose dopamine or low-dose nesiritide in acute heart failure with kidney dysfunction (ROSE-AHF) trial, in which all patients received aggressive diuresis regardless of randomization, showed that increases in either serum creatinine or markers of tubular damage were not only poorly correlated with each other and with diuretic effect, but also may have contributed to premature cessation of decongestive therapies.21Ahmad T. Jackson K. Rao V.S. et al.Worsening renal function in acute heart failure patients undergoing aggressive diuresis is not associated with tubular injury.Circulation. 2018; 137: 2016-2028Crossref PubMed Scopus (164) Google Scholar These results also lend support to the notion that the increase in serum creatinine could result from changes in renal hemodynamics (eg, renal venous congestion) in a subset of patients. The negative results of CARRESS-HF contrasted those of UNLOAD and several previous uncontrolled trials. Because of the differences in the design and delivery of the interventions, there seemed to be an unmet need for a fair comparison between a protocolized diuretic regimen with a well-done algorithm-based UF therapy. The Aquapheresis Versus Intravenous Diuretics and Hospitalization for Heart Failure (AVOID-HF) trial was designed to address this knowledge gap.22Costanzo M.R. Negoianu D. Jaski B.E. et al.Aquapheresis versus intravenous diuretics and hospitalizations for heart failure.JACC Heart Fail. 2016; 4: 95-105Crossref PubMed Scopus (115) Google Scholar The study had been designed to include over 800 patients with ADHF, but it was terminated before the target enrollment because of a slower than expected recruitment rate. As such, despite being the largest study thus far (including 224 patients), its findings do need to be interpreted with caution. AVOID-HF compared early adjustable UF therapy with a well-designed medical treatment protocol that had similarities with the algorithm used in the CARRESS-HF. The UF rate varied from 50 to 300 mL/h (an average of 138 mL/h) for a median of 70 hours. The total and net fluid losses were again found to be greater in the UF group than in the diuretic arm (18.7 vs 14 L; P = .02 and 12.9 vs 8.9 L; P < .01, respectively) without an adverse impact on kidney function. The patients in the UF arm showed a nonsignificant trend toward better outcomes such as higher estimated number of days to first HF event (62 for UF vs 34 days for medical management; P = .11) within 90 days after discharge. Despite early termination of the trial, there was still sufficient evidence to show a number of clinically relevant benefits for UF within the first month of discharge such as fewer patients readmitted for HF. Although the elegant design of AVOID-HF provided the possibility of a fair comparison between the 2 therapeutic modalities, the possibility of a bias may not be completely eliminated because the investigators could not be blinded to the treatment assignment and the chosen primary end point (ie, HF rehospitalization) could be affected by their postdischarge management (unlike the primary end point in the CARRESS-HF or UNLOAD). To consolidate data across several studies, Jain and colleagues23Jain A. Agrawal N. Kazory A. Defining the role of ultrafiltration therapy in acute heart failure: a systematic review and meta-analysis.Heart Fail Rev. 2016; 21: 611-619Crossref PubMed Scopus (13) Google Scholar performed a meta-analysis of 7 RCTs of UF including a total of 771 patients. It showed that UF therapy is associated with more efficient decongestion as measured by weight loss (weighted mean difference 1.35, 95% confidence interval [CI] 0.49-2.21, P < .01) and net fluid removal (weighted mean difference 1.81, 95% CI 1.01-2.62, P < .01) compared with medical treatment. Although the investigators found similar changes in kidney function for both groups, UF was shown to be more efficient at reducing the rate of HF rehospitalization (odds ratio 0.6, CI 0.37-0.98, P = .04). There was no difference in mortality or rate of adverse events. The results of this meta-analysis lend support to the notion that the high rate of HF rehospitalization in patients with ADHF could in part be related to suboptimal decongestion during index hospital admission as the therapy with better decongestive properties led to the improved rate of readmission. It also implies that UF could potentially have a role in reduction of HF-related cost as most of the expenditure is related to the inpatient care of these patients. However, future studies are needed to determine whether the higher upfront cost of this extracorporeal modality will be offset by reduction in the expenses related to subsequent hospitalization of these patients. Selected RCTs on the role of UF in ADHF are summarized in Table 2.Table 2Selected Randomized Controlled Trials of UF for ADHFAdapted and reprinted with permission from Springer Nature: Jain and colleagues,23Jain A. Agrawal N. Kazory A. Defining the role of ultrafiltration therapy in acute heart failure: a systematic review and meta-analysis.Heart Fail Rev. 2016; 21: 611-619Crossref PubMed Scopus (13) Google Scholar copyright 2016.StudyRAPID-CHF24Bart B.A. Boyle A. Bank A.J. et al.Ultrafiltration versus usual care for hospitalized patients with heart failure: the relief for acutely fluid-overloaded patients with decompensated congestive heart failure.J Am Coll Cardiol. 2005; 46: 2043-2046Crossref PubMed Scopus (324) Google ScholarUNLOAD15Costanzo M.R. Guglin M.E. Saltzberg M.T. et al.Ultrafiltration versus intravenous diuretics for patients hospitalized for acute decompensated heart failure.J Am Coll Cardiol. 2007; 49: 675-683Crossref PubMed Scopus (840) Google ScholarULTRADISCO25Giglioli C. Landi D. Cecchi E. et al.Effects of ULTRAfiltration vs. DIureticS on clinical, biohumoral and haemodynamic variables in patients with deCOmpensated heart failure: the ULTRADISCO study.Eur J Heart Fail. 2011; 13: 337-346Crossref PubMed Scopus (103) Google ScholarHanna and colleagues26Hanna M.A. Tang W.H. Teo B.W. et al.Extracorporeal ultrafiltration vs. conventional diuretic therapy in advanced decompensated heart failure.Congest Heart Fail. 2012; 18: 54-63Google ScholarCARRESS-HF17Bart B.A. Goldsmith S.R. Lee K.L. et al.Ultrafiltration in decompensated heart failure with cardiorenal syndrome.N Engl J Med. 2012; 367: 2296-2304Crossref PubMed Scopus (635) Google ScholarCUORE27Marenzi G. Muratori M. Cosentino E.R. et al.Continuous ultrafiltration for congestive heart failure.J Card Fail. 2014; 20 (e1-e9): 378Google ScholarAVOID-HF22Costanzo M.R. Negoianu D. Jaski B.E. et al.Aquapheresis versus intravenous diuretics and hospitalizations for heart failure.JACC Heart Fail. 2016; 4: 95-105Crossref PubMed Scopus (115) Google ScholarYear of publication2005200720112012201220142016Number of centers6281122230Number of patients40 (20 UF, 20 PT)200 (100 UF, 100 PT)30 (15 UF, 15 PT)36 (17 UF, 19 PT)188 (94 UF, 94 PT)56 (27 UF, 29 PT)224 (110 UF, 114 PT)Study design and protocolEarly single UF session plus usual care vs usual care aloneSingle session early UF therapy for ADHF (within 24 h)Slow continuous UF, hemodynamic changes were monitored by pressure recording analytical methodSlow continuous UF for ADHF, patients were randomized within 2 strata based on baseline GFRRescue therapy for patients with both ADHF and worsening kidney functionOne or 2 early UF treatments for ADHF (within 24 h)Single session early UF therapy for ADHF (within 24 h)Primary end pointWeight loss at 24 hWeight loss and dyspnea at 48 h (efficacy), changes in kidney function and hypotension (safety)Change in clinical, biohumoral, and hemodynamic parametersTime for PCWP to be kept at ≤18 mm Hg for at least 4 consecutive hoursThe changes in Scr and weight at 96 h (bivariate)Rehospitalization rate for HF at 1 yTime to first HF event within 90 d after dischargeUltrafiltration regimenSingle, 8-h UF session with fluid removal rates to a maximum of 500 mL/hDuration and rate of UF flexible, maximum UF rate 500 mL/h, average UF rate 241 mL/h for 12.3 ± 12 hBlood flow rate of 150 mL/h, adjustable UF rate of 100-300 mL/hBlood flow rate of 200-300 mL/min, UF rate of 400 mL/h for 6 h and then 200 mL/hFixed UF rate 200 mL/h, median duration of UF 40 h, median duration 40 hDuration and rate of UF flexible, maximum UF rate 500 mL/h, average duration 19 ± 10 hDuration and rate of UF flexible, maximum UF rate 500 mL/h, average UF rate 138 mL/h for 80 ± 53 hMedical therapyConventional pharmacologic therapy (no preplanned algorithm)Conventional pharmacologic therapy (no preplanned algorithm)Conventional pharmacologic therapy (no preplanned algorithm)Conventional pharmacologic therapy (no preplanned algorithm)Stepped pharmacologic therapy (algorithm-based)Conventional pharmacologic therapy (no preplanned algorithm)Adjustable intravenous loop diuretics (algorithm-based)Age (y)67.5 UF, 69.5 PT62 UF, 63 PT72 UF, 66 PT60 UF, 59 PT69 UF, 66 PT75 UF, 73 PT67 UF, 67 PTMale gender (%)70 UF, 70 PT70 UF, 68 PT87 UF, 87 PT84 UF, 76 PT78 UF, 72 PT81 UF, 83 PT69 UF, 73 PTWeight (kg)NR101 UF, 96 PT74 UF, 83 PT93 UF, 98 PT94 UF, 106 PT83 UF, 89 PT110 UF, 111 PTLVEF (%)69 UF∗Percent of patients with LVEF ≤40%., 78 PT∗Percent of patients with LVEF ≤40%.71 UF∗Percent of patients with LVEF ≤40%., 70 PT∗Percent of patients with LVEF ≤40%.34 UF, 30 PT19 UF, 18 PT30 UF, 35 PT32 UF, 32 PT36 UF, 37 PTBaseline SCr (mg/dL)1.6 UF, 1.8 PT1.5 UF, 1.5 PT (Scr >3 mg/dL excluded)2.2 UF, 1.9 PT (Scr >3.0 mg/dL excluded)55 UF, 51 PT†eGFR. (eGFR <15 excluded)1.9 UF, 2.09 PT (Scr >3.5 mg/dL excluded)1.7 UF, 1.9 PT (Scr >3 mg/dL excluded)1.5 UF, 1.6 PT (Scr ≥3 mg/dL excluded)Impact on kidney functionNo significant difference in kidney function between UF and PTNo significant difference in kidney function between UF and PTNo significant difference in kidney function between UF and PTNo significant difference in kidney function between UF and PTSignificant increase in Scr level with UF, no change in Scr for PTHigher Scr and BUN in the PT group at 6 mo, No difference in eGFR, Scr, and BUN between UF and PT at 1 yNo significant difference in eGFR, Scr, BUN, and BUN/Scr ratio during treatment and up to 90 d between UF and PTImpact on congestionGreater net fluid loss with UF, no significant difference in weight lossGreater weight loss with UF, greater net fluid loss with UFWeight loss and total amount of fluid removal similar for both groupsSimilar total volume extraction for UF and PT, significantly higher fluid removal rate with UFWeight loss and total amount of fluid removal similar for both groupsWeight loss similar for both groups at discharge, lower body weight for UF at 1 yHigher total amount of fluid removed with UF, no difference in weight loss between UF and PTFollow-up1 mo3 mo36 h3 mo2 mo12 mo3 moAbbreviations: ADHF, acute decompensated heart failure; AVOID-HF, Aquapheresis Versus Intravenous Diuretics and Hospitalization for Heart Failure; BUN, blood urea nitrogen; CARRESS-HF, Cardiorenal Rescue Study in Acute Decompensated Heart Failure; CUORE, Continuous Ultrafiltration for Congestive Heart Failure; eGFR, estimated glomerular filtration rate; HF, heart failure; LVEF, left ventricular ejection fraction; NR, not reported; PCWP, pulmonary capillary wedge pressure; PT, pharmacologic therapy; RAPID-CHF, Relief for Acutely Fluid-Overloaded Patients with Decompensated Congestive Heart Failure; Scr, serum creatinine; UF, ultrafiltration; ULTRADISCO, Effects of Ultrafiltration Versus Diuretics on Clinical, Biohumoral and Hemodynamic Variables in Patients with Decompensated Heart Failure; UNLOAD, Ultrafiltration Versus Intravenous Diuretics for Patients Hospitalized for Acute Decompensated Congestive Heart Failure.∗ Percent of patients with LVEF ≤40%.† eGFR. Open table in a new tab" @default.
• W2897855204 created "2018-10-26" @default.
• W2897855204 creator A5014244466 @default.
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• W2897855204 date "2018-09-01" @default.
• W2897855204 modified "2023-09-25" @default.
• W2897855204 title "Extracorporeal Isolated Ultrafiltration for Management of Congestion in Heart Failure and Cardiorenal Syndrome" @default.
• W2897855204 cites W1489755771 @default.
• W2897855204 cites W1518833762 @default.
• W2897855204 cites W1856995505 @default.
• W2897855204 cites W1969091056 @default.
• W2897855204 cites W1991293397 @default.
• W2897855204 cites W1993823264 @default.
• W2897855204 cites W2001548692 @default.
• W2897855204 cites W2002897162 @default.
• W2897855204 cites W2014842521 @default.
• W2897855204 cites W2024780303 @default.
• W2897855204 cites W2038813835 @default.
• W2897855204 cites W2039683222 @default.
• W2897855204 cites W2047338175 @default.
• W2897855204 cites W2054105133 @default.
• W2897855204 cites W2071369944 @default.
• W2897855204 cites W2075027799 @default.
• W2897855204 cites W2075122399 @default.
• W2897855204 cites W2080501116 @default.
• W2897855204 cites W2095103765 @default.
• W2897855204 cites W2103080316 @default.
• W2897855204 cites W2104547465 @default.
• W2897855204 cites W2111627374 @default.
• W2897855204 cites W2113313693 @default.
• W2897855204 cites W2113698123 @default.
• W2897855204 cites W2119875370 @default.
• W2897855204 cites W2132002786 @default.
• W2897855204 cites W2132800785 @default.
• W2897855204 cites W2157305023 @default.
• W2897855204 cites W2169268865 @default.
• W2897855204 cites W2169828239 @default.
• W2897855204 cites W2170131723 @default.
• W2897855204 cites W2171352435 @default.
• W2897855204 cites W2323686581 @default.
• W2897855204 cites W2331149975 @default.
• W2897855204 cites W2334007412 @default.
• W2897855204 cites W2346922973 @default.
• W2897855204 cites W2461008830 @default.
• W2897855204 cites W2517444660 @default.
• W2897855204 cites W2582619141 @default.
• W2897855204 cites W2610322167 @default.
• W2897855204 cites W2784257687 @default.
• W2897855204 cites W2789722358 @default.
• W2897855204 cites W2796595615 @default.
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