Ultrafiltration for the treatment of diuretic-resistant, recurrent, acute decompensated heart failure: experience in a single center

Abstract

Purpose of study: We report our experience with ultrafiltration to remove fluid overload in patients with diuretic-resistant, decompensated, congestive heart failure.

Methods: From 2005 to 2008, 42 patients with heart failure and left ventricular ejection fraction less than 40% were treated with ultrafiltration. Patients were hospitalized for acute decompensation. Mean age was 69 years (67% men). Cause of heart failure was ischemic in 52% of cases. New York Heart Association (NYHA) class was III (64%) or IV (36%). All patients were on optimal heart failure drugs. Average dose of furosemide before ultrafiltration was 250 mg. Exclusion criteria were contraindications to anticoagulants, hematocrit more than 50%, glomerular filtration rate less than 30 ml/min and cardiogenic shock. Ultrafiltration was performed using a venous femoral bilumen catheter and anticoagulation with heparin.

Results: Each patient underwent one to four ultrafiltration treatments (total 70). Mean duration of a treatment was 6 h. Eighty-six percent of treatments removed more than 4000 ml of fluids; 10% removed 2000-4000 ml; 4% removed less than 2000 ml (1600-6900 ml). One ultrafiltration was aborted because of persistent hypotension. Other complications include two cases of bleeding from vascular access and six cases of worsened renal function. One patients required dialysis. Six-month mortality after ultrafiltration was 26%. Hospitalization rate, 6 months after, was 30% (compared to 66% 6 months before). Average furosemide dose, 6 months after, was 125 mg.

Conclusion: Ultrafiltration removed fluid overload in diuretic-resistant, severe, congestive heart failure in our single-center experience. Six months after ultrafiltration, hospitalization rates were reduced by 36% and furosemide dose was 50% lower, compared to the previous 6 months. Worsened renal function was the most common complication (14% of patients).