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BMC Cardiovascular Disorders

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Open Access 01-12-2020 | Dyspnea | Research article

Efficacy and safety of early ultrafiltration in patients with acute decompensated heart failure with volume overload: a prospective, randomized, controlled clinical trial

Authors: Jingyi Hu, Qianli Wan, Yue Zhang, Jun Zhou, Miaomiao Li, Li Jiang, Fang Yuan

Published in: BMC Cardiovascular Disorders | Issue 1/2020

Abstract

Background

Ultrafiltration decreases total body water and improves the alveolar to arterial oxygen gradient. The aims of the study were to investigate the efficacy and safety of early ultrafiltration in acute decompensated heart failure (ADHF) patients.

Methods

100 patients with ADHF within 24 h of admission were randomly assigned into early ultrafiltration (n = 40) or torasemide plus tolvaptan (n = 60) groups. The primary outcomes were weight loss and an increase in urine output on days 4 and 8 of treatment.

Results

Patients who received early ultrafiltration for 3 days achieved a greater weight loss (kg) (− 2.94 ± 3.76 vs − 0.64 ± 0.91, P < 0.001) and urine increase (mL) (198.00 ± 170.70 vs 61.77 ± 4.67, P < 0.001) than the torasemide plus tolvaptan group on day 4. From days 4 to 7, patients in the early ultrafiltration group received sequential therapy of torasemide and tolvaptan. Better control of volume was reflected in a greater weight loss (− 3.72 ± 3.81 vs − 1.34 ± 1.32, P < 0.001) and urine increase (373.80 ± 120.90 vs 79.5 ± 52.35, P < 0.001), greater reduction of B-type natriuretic peptide (BNP) (pg/mL) (− 1144 ± 1435 vs − 654.02 ± 889.65, P = 0.037), NYHA (New York Heart Association) functional class (− 1.45 ± 0.50 vs − 1.17 ± 0.62, P = 0.018), jugular venous pulse (JVP) score (points) (− 1.9 ± 1.13 vs − 0.78 ± 0.69, P < 0.001), inferior vena cava (IVC) diameter (mm) (− 15.35 ± 11.03 vs − 4.98 ± 6.00, P < 0.001) and an increase in the dyspnea score (points) (4.08 ± 3.44 vs 2.77 ± 2.03, P = 0.035) in the early ultrafiltration group on day 8. No significant differences were found in the readmission and mortality rates in the 2 patient groups at the 1-month and 3-month follow-ups. Both groups had a similar stable renal profile.

Conclusion

Early ultrafiltration is superior to diuretics for volume overload treatment initiation of ADHF patients.

Trial registration Chinese Clinical Trial Registry, ChiCTR2000030696, Registered 10 March 2020—Retrospectively registered, https://www.chictr.org.cn/showproj.aspx?proj=29099.

Farmakis D, Parissis J, Lekakis J, Filippatos G. Acute heart failure: epidemiology, risk factors, and prevention. Rev Esp Cardiol (Engl Ed). 2015;68(3):245–8.

Adams KF, Fonarow GC, Emerman CL, LeJemtel TH, Costanzo MR, Abraham WT, et al. Characteristics and outcomes of patients hospitalized for heart failure in the United States: Rationale, design, and preliminary observations from the first 100,000 cases in the Acute Decompensated Heart Failure National Registry (ADHERE). Am Heart J. 2005;149(2):209–16.PubMed

Gheorghiade M, Follath F, Ponikowski P, Barsuk JH, Blair JEA, Cleland JG, et al. Assessing and grading congestion in acute heart failure: a scientific statement from the Acute Heart Failure Committee of the Heart Failure Association of the European Society of Cardiology and endorsed by the European Society of Intensive Care Medicine. Eur J Heart Fail. 2010;12(5):423–33.PubMed

Gheorghiade M, Filippatos G, De Luca L, Burnett J. Congestion in acute heart failure syndromes: an essential target of evaluation and treatment. Am J Med. 2006;119(12):S3–10.PubMed

Testani JM, Chen J, McCauley BD, Kimmel SE, Shannon RP. Potential effects of aggressive decongestion during the treatment of decompensated heart failure on renal function and survival. Circulation. 2010;122(3):265–72.PubMedPubMedCentral

Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail. 2016;18(8):891–975.PubMed

Chiong JR, Cheung RJ. Loop diuretic therapy in heart failure: the need for solid evidence on a fluid issue. Clin Cardiol. 2010;33(6):345–52.PubMedPubMedCentral

Fonarow GC, Adams KF Jr, Abraham WT, Yancy CW, Boscardin WJ. Risk stratification for in-hospital mortality in acutely decompensated heart failure: classification and regression tree analysis. JAMA. 2005;293(5):572–80.PubMed

Fonarow GC. Epidemiology and risk stratification in acute heart failure. Am Heart J. 2008;155(2):200–7.PubMed

10.

Krumholz HM, Parent EM, Tu N, Vaccarino V, Wang Y, Radford MJ, et al. Readmission after hospitalization for congestive heart failure among Medicare beneficiaries. Arch Intern Med. 1997;157(1):99–104.PubMed

11.

Ko DT, Alter DA, Austin PC, You JJ, Lee DS, Qiu F, et al. Life expectancy after an index hospitalization for patients with heart failure: a population-based study. Am Heart J. 2008;155(2):324–31.PubMed

12.

Goh CY, Vizzi G, De Cal M, Ronco C. Cardiorenal syndrome: a complex series of combined heart/kidney disorders. Contrib Nephrol. 2011;174:33–45.PubMed

13.

Shchekochikhin D, Al Ammary F, Lindenfeld JA, Schrier R. Role of diuretics and ultrafiltration in congestive heart failure. Pharmaceuticals (Basel). 2013;6(7):851–66.

14.

Lu R, Muciño-Bermejo MJ, Ribeiro LC, Tonini E, Estremadoyro C, Samoni S, et al. Peritoneal dialysis in patients with refractory congestive heart failure: a systematic review. Cardiorenal Med. 2015;5(2):145–56.PubMedPubMedCentral

15.

Ronco C, Ricci Z, Bellomo R, Bedogni F. Extracorporeal ultrafiltration for the treatment of overhydration and congestive heart failure. Cardiology. 2001;96(3–4):155–68.PubMed

16.

Bart BA, Boyle A, Bank AJ, Anand I, Olivari MT, Kraemer M, et al. Ultrafiltration versus usual care for hospitalized patients with heart failure: the Relief for Acutely Fluid-Overloaded Patients With Decompensated Congestive Heart Failure (RAPID-CHF) trial. J Am Coll Cardiol. 2005;46(11):2043–6.PubMed

17.

Costanzo MR, Guglin ME, Saltzberg MT, Jessup ML, Bart BA, Teerlink JR, et al. Ultrafiltration versus intravenous diuretics for patients hospitalized for acute decompensated heart failure. J Am Coll Cardiol. 2007;49(6):675–83.PubMed

18.

Hanna MA, Tang WH, Teo BW, O’Neill JO, Weinstein DM, Lau SM, et al. Extracorporeal ultrafiltration vs. conventional diuretic therapy in advanced decompensated heart failure. Congest Heart Fail. 2012;18(1):54–63.PubMed

19.

Siddiqui WJ, Kohut AR, Hasni SF, Goldman JM, Silverman B, Kelepouris E, et al. Readmission rate after ultrafiltration in acute decompensated heart failure: a systematic review and meta-analysis. Heart Fail Rev. 2017;22(6):685–98.PubMed

20.

Chung ES, O’Brien TM, Menon S, Bartone C, Mazur W, Kereiakes DJ. A pilot study of target weight guided treatment in acute heart failure using ultrafiltration or usual care: effect on sodium removal. Korean Circ J. 2014;44(3):156–61.PubMedPubMedCentral

21.

Grodin JL, Carter S, Bart BA, Goldsmith SR, Drazner MH, Tang WHW. Direct comparison of ultrafiltration to pharmacological decongestion in heart failure: a per-protocol analysis of CARRESS-HF. Eur J Heart Fail. 2018;20(7):1148–56.PubMed

22.

Bart BA, Goldsmith SR, Lee KL, Givertz MM, O’Connor CM, Bull DA, et al. Ultrafiltration in decompensated heart failure with cardiorenal syndrome. N Engl J Med. 2012;367(24):2296–304.PubMedPubMedCentral

23.

Costanzo MR, Saltzberg MT, Jessup M, Teerlink JR, Sobotka PA. Ultrafiltration is associated with fewer rehospitalizations than continuous diuretic infusion in patients with decompensated heart failure: results from UNLOAD. J Card Fail. 2010;16(4):277–84.PubMed

24.

Jaski BE, Ha J, Denys BG, Lamba S, Trupp RJ, Abraham WT. Peripherally inserted veno-venous ultrafiltration for rapid treatment of volume overloaded patients. J Card Fail. 2003;9(3):227–31.PubMed

25.

Costanzo MR, Saltzberg M, O’Sullivan J, Sobotka P. Early ultrafiltration in patients with decompensated heart failure and diuretic resistance. J Am Coll Cardiol. 2005;46(11):2047–51.PubMed

26.

Bart BA, Boyle A, Bank AJ, Anand I, Olivari MT, Kraemer M, et al. Randomized controlled trial of ultrafiltration versus usual care for hospitalized patients with heart failure: preliminary report of the rapid trial. J Cardiac Fail. 2004;10(4):S23.

27.

Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Colvin MM, et al. 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation. 2017;136(6):e137–61.PubMed

28.

Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315(8):801–10.PubMedPubMedCentral

29.

Pang PS, Cleland JG, Teerlink JR, Collins SP, Lindsell CJ, Sopko G, et al. A proposal to standardize dyspnoea measurement in clinical trials of acute heart failure syndromes: the need for a uniform approach. Eur Heart J. 2008;29(6):816–24.PubMed

30.

Dao Q, Krishnaswamy P, Kazanegra R, Harrison A, Amirnovin R, Lenert L, et al. Utility of B-type natriuretic peptide in the diagnosis of congestive heart failure in an urgent-care setting. J Am Coll Cardiol. 2001;37(2):379–85.PubMed

31.

Teo LY, Lim CP, Neo CL, Teo LW, Ng SL, Chan LL, et al. Ultrafiltration in patients with decompensated heart failure and diuretic resistance: an Asian centre’s experience. Singapore Med J. 2016;57(7):378–83.PubMedPubMedCentral

32.

Agostoni P, Marenzi G, Lauri G, Perego G, Schianni M, Sganzerla P, et al. Sustained improvement in functional capacity after removal of body fluid with isolated ultrafiltration in chronic cardiac insufficiency: failure of furosemide to provide the same result. Am J Med. 1994;96(3):191–9.PubMed

33.

Ellison DH. Diuretic therapy and resistance in congestive heart failure. Cardiology. 2001;96(3–4):132–43.PubMed

34.

Bart BA. 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(5):499–504.PubMed

35.

Felker GM, Mentz RJ. Diuretics and ultrafiltration in acute decompensated heart failure. J Am Coll Cardiol. 2012;59(24):2145–53.PubMed

36.

Libetta C, Sepe V, Zucchi M, Campana C, Dal Canton A. Standard hemodiafiltration improves diuretic responsiveness in advanced congestive heart failure. Cardiology. 2006;105(2):122–3.PubMed

37.

Nakagawa O, Ogawa Y, Itoh H, Suga S, Komatsu Y, Kishimoto I, et al. Rapid transcriptional activation and early mRNA turnover of brain natriuretic peptide in cardiocyte hypertrophy. Evidence for brain natriuretic peptide as an “emergency” cardiac hormone against ventricular overload. J Clin Investig. 1995;96(3):1280–7.PubMedPubMedCentral

38.

Dickstein K. Natriuretic peptides in detection of heart failure. Lancet. 1998;351(9095):4.PubMed

39.

Maeda K, Tsutamoto T, Wada A, Hisanaga T, Kinoshita M. Plasma brain natriuretic peptide as a biochemical marker of high left ventricular end-diastolic pressure in patients with symptomatic left ventricular dysfunction. Am Heart J. 1998;135(5 Pt 1):825–32.PubMed

40.

Clerico A, Iervasi G, Del Chicca MG, Emdin M, Maffei S, Nannipieri M, et al. Circulating levels of cardiac natriuretic peptides (ANP and BNP) measured by highly sensitive and specific immunoradiometric assays in normal subjects and in patients with different degrees of heart failure. J Endocrinol Invest. 1998;21(3):170–9.PubMed

41.

Korhan E, Selçuk S, Bülent U. Early ultrafiltration therapy in a patient with decompansated heart failure and acute pulmonary edema in the setting of diuretic resistance. Ann Med Res. 2007;14(2):111–3.

42.

Dahle TG, Blake D, Ali SS, Olinger CC, Bunte MC, Boyle AJ. Large volume ultrafiltration for acute decompensated heart failure using standard peripheral intravenous catheters. J Card Fail. 2006;12(5):349–52.PubMed

43.

Giglioli C, Landi D, Cecchi E, Chiostri M, Gensini GF, Valente S, 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(3):337–46.PubMed

44.

Pang PS, Gheorghiade M, Dihu J, Swedberg K, Khan S, Maggioni AP, et al. Effects of tolvaptan on physician-assessed symptoms and signs in patients hospitalized with acute heart failure syndromes: analysis from the efficacy of vasopressin antagonism in heart failure outcome study with tolvaptan (EVEREST) trials. Am Heart J. 2011;161(6):1067–72.PubMed

45.

Pang PS, Konstam MA, Krasa HB, Swedberg K, Zannad F, Blair JEA, et al. Effects of tolvaptan on dyspnoea relief from the EVEREST trials. Eur Heart J. 2009;30(18):2233–40.PubMedPubMedCentral

46.

Felker GM, Mentz RJ, Cole RT, Adams KF, Egnaczyk GF, Fiuzat M, et al. Efficacy and safety of tolvaptan in patients hospitalized with acute heart failure. J Am Coll Cardiol. 2017;69(11):1399–406.PubMed

47.

Heart Failure Professional Committee of Chinese Medical Docter Association, Editorial Board of Chinses Jourol of Heart Failure and Cardiomyopathy. Expert recommendation on the voume control in heart failure management. Chin J Heart Fail Cardiomyopathy. 2018;2(1):8–16.

48.

Association CSoCoCM, Cardiology EBoCJo. Guidelines for the diagnosis and management of chronic heart failure. Chin J Cardiol. 2007;35(12):1076–95.

Title: Efficacy and safety of early ultrafiltration in patients with acute decompensated heart failure with volume overload: a prospective, randomized, controlled clinical trial
Authors: Jingyi Hu
Qianli Wan
Yue Zhang
Jun Zhou
Miaomiao Li
Li Jiang
Fang Yuan
Publication date: 01-12-2020
Publisher: BioMed Central
Keywords: Dyspnea
Diuretics
Heart Failure
Dyspnea
Torasemide
Published in: BMC Cardiovascular Disorders / Issue 1/2020
Electronic ISSN: 1471-2261
DOI: https://doi.org/10.1186/s12872-020-01733-5

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