Extracorporeal Ultrafiltration for Fluid Overload in Heart Failure: Current Status and Prospects for Further Research

Maria Rosa Costanzo, Claudio Ronco, William T. Abraham, Piergiuseppe Agostoni, Jonathan Barasch, Gregg C. Fonarow, Stephen S. Gottlieb, Brian E. Jaski, Amir Kazory, Allison P. Levin, Howard R. Levin, Giancarlo Marenzi, Wilfried Mullens, Dan Negoianu, Margaret M. Redfield, W. H.Wilson Tang, Jeffrey M. Testani, Adriaan A. Voors

Research output: Contribution to journalReview article

Abstract

More than 1 million heart failure hospitalizations occur annually, and congestion is the predominant cause. Rehospitalizations for recurrent congestion portend poor outcomes independently of age and renal function. Persistent congestion trumps serum creatinine increases in predicting adverse heart failure outcomes. No decongestive pharmacological therapy has reduced these harmful consequences. Simplified ultrafiltration devices permit fluid removal in lower-acuity hospital settings, but with conflicting results regarding safety and efficacy. Ultrafiltration performed at fixed rates after onset of therapy-induced increased serum creatinine was not superior to standard care and resulted in more complications. In contrast, compared with diuretic agents, some data suggest that adjustment of ultrafiltration rates to patients’ vital signs and renal function may be associated with more effective decongestion and fewer heart failure events. Essential aspects of ultrafiltration remain poorly defined. Further research is urgently needed, given the burden of congestion and data suggesting sustained benefits of early and adjustable ultrafiltration.

Original languageEnglish
Pages (from-to)2428-2445
Number of pages18
JournalJournal of the American College of Cardiology
Volume69
Issue number19
DOIs
Publication statusPublished - May 16 2017

Keywords

  • biomarkers
  • creatinine
  • diuretics
  • glomerular filtration rate
  • venous congestion

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Costanzo, M. R., Ronco, C., Abraham, W. T., Agostoni, P., Barasch, J., Fonarow, G. C., Gottlieb, S. S., Jaski, B. E., Kazory, A., Levin, A. P., Levin, H. R., Marenzi, G., Mullens, W., Negoianu, D., Redfield, M. M., Tang, W. H. W., Testani, J. M., & Voors, A. A. (2017). Extracorporeal Ultrafiltration for Fluid Overload in Heart Failure: Current Status and Prospects for Further Research. Journal of the American College of Cardiology, 69(19), 2428-2445. https://doi.org/10.1016/j.jacc.2017.03.528