Intermittent haemodiafiltration in refractory congestive heart failure: BNP and balance of inflammatory cytokines

Carmelo Libetta, Vincenzo Sepe, Manuela Zucchi, Patrizia Pisacco, Laura Cosmai, Federica Meloni, Carlo Campana, Teresa Rampino, Cristina Monti, Luigi Tavazzi, Antonio Dal Canton

Research output: Contribution to journalArticle

Abstract

Background. Elevated plasma levels of cytokines have been associated with an increased risk of congestive heart failure (CHF) even in people without history of myocardial infarction. Here we have tested the hypothesis that effective removal of pro-inflammatory cytokines in patients with advanced CHF unresponsive to diuretic treatment is associated with diuresis restoration and with a significant reduction of B-type natriuretic peptide (BNP) circulating levels. Methods. We prospectively enrolled 10 patients with decompensated CHF (NYHA classes III-IV). Five patients unresponsive to diuretic treatment underwent a short course of intermittent haemodiafiltration (iHDF), whereas five patients responsive to diuretics were treated with intravenous boluses of furosemide. Renal function was similar between the two groups. Results. Excess body fluids were removed in both groups always resulting in a reduction of pulmonary congestion and peripheral oedema. NYHA class improved in all patients, but one treated by intravenous boluses of furosemide. Only patients treated with iHDF showed a significant reduction of circulating interleukin-8 and monocyte chemoattractant protein-1. After the end of iHDF treatment, patients showed consistent restoration of diuretic responsiveness to significantly lower doses of oral furosemide up to one month of follow-up. Plasma levels of BNP before treatment were significantly higher in the iHDF group, lowering significantly in both groups after treatment. Conclusions. Our results suggest that HDF is an effective treatment for patients with advanced CHF when cytokines have to be cleared and diuretic responsiveness needs to be restored. In our experience, iHDF is a cost-effective option when compared with continuous ultrafiltration methods because it can be performed in a routine dialysis unit without adjunctive costs for machinery or personnel training.

Original languageEnglish
Pages (from-to)2013-2019
Number of pages7
JournalNephrology Dialysis Transplantation
Volume22
Issue number7
DOIs
Publication statusPublished - Jul 2007

Fingerprint

Hemodiafiltration
Brain Natriuretic Peptide
Heart Failure
Cytokines
Diuretics
Furosemide
Therapeutics
Costs and Cost Analysis
Chemokine CCL2
Diuresis
Ultrafiltration
Body Fluids
Interleukin-8
Dialysis
Edema
Myocardial Infarction
Kidney
Lung

Keywords

  • BNP
  • Congestive heart failure
  • Cytokines
  • Furosemide
  • Haemodiafiltration

ASJC Scopus subject areas

  • Nephrology
  • Transplantation

Cite this

Intermittent haemodiafiltration in refractory congestive heart failure : BNP and balance of inflammatory cytokines. / Libetta, Carmelo; Sepe, Vincenzo; Zucchi, Manuela; Pisacco, Patrizia; Cosmai, Laura; Meloni, Federica; Campana, Carlo; Rampino, Teresa; Monti, Cristina; Tavazzi, Luigi; Dal Canton, Antonio.

In: Nephrology Dialysis Transplantation, Vol. 22, No. 7, 07.2007, p. 2013-2019.

Research output: Contribution to journalArticle

Libetta, Carmelo ; Sepe, Vincenzo ; Zucchi, Manuela ; Pisacco, Patrizia ; Cosmai, Laura ; Meloni, Federica ; Campana, Carlo ; Rampino, Teresa ; Monti, Cristina ; Tavazzi, Luigi ; Dal Canton, Antonio. / Intermittent haemodiafiltration in refractory congestive heart failure : BNP and balance of inflammatory cytokines. In: Nephrology Dialysis Transplantation. 2007 ; Vol. 22, No. 7. pp. 2013-2019.
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abstract = "Background. Elevated plasma levels of cytokines have been associated with an increased risk of congestive heart failure (CHF) even in people without history of myocardial infarction. Here we have tested the hypothesis that effective removal of pro-inflammatory cytokines in patients with advanced CHF unresponsive to diuretic treatment is associated with diuresis restoration and with a significant reduction of B-type natriuretic peptide (BNP) circulating levels. Methods. We prospectively enrolled 10 patients with decompensated CHF (NYHA classes III-IV). Five patients unresponsive to diuretic treatment underwent a short course of intermittent haemodiafiltration (iHDF), whereas five patients responsive to diuretics were treated with intravenous boluses of furosemide. Renal function was similar between the two groups. Results. Excess body fluids were removed in both groups always resulting in a reduction of pulmonary congestion and peripheral oedema. NYHA class improved in all patients, but one treated by intravenous boluses of furosemide. Only patients treated with iHDF showed a significant reduction of circulating interleukin-8 and monocyte chemoattractant protein-1. After the end of iHDF treatment, patients showed consistent restoration of diuretic responsiveness to significantly lower doses of oral furosemide up to one month of follow-up. Plasma levels of BNP before treatment were significantly higher in the iHDF group, lowering significantly in both groups after treatment. Conclusions. Our results suggest that HDF is an effective treatment for patients with advanced CHF when cytokines have to be cleared and diuretic responsiveness needs to be restored. In our experience, iHDF is a cost-effective option when compared with continuous ultrafiltration methods because it can be performed in a routine dialysis unit without adjunctive costs for machinery or personnel training.",
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T2 - BNP and balance of inflammatory cytokines

AU - Libetta, Carmelo

AU - Sepe, Vincenzo

AU - Zucchi, Manuela

AU - Pisacco, Patrizia

AU - Cosmai, Laura

AU - Meloni, Federica

AU - Campana, Carlo

AU - Rampino, Teresa

AU - Monti, Cristina

AU - Tavazzi, Luigi

AU - Dal Canton, Antonio

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N2 - Background. Elevated plasma levels of cytokines have been associated with an increased risk of congestive heart failure (CHF) even in people without history of myocardial infarction. Here we have tested the hypothesis that effective removal of pro-inflammatory cytokines in patients with advanced CHF unresponsive to diuretic treatment is associated with diuresis restoration and with a significant reduction of B-type natriuretic peptide (BNP) circulating levels. Methods. We prospectively enrolled 10 patients with decompensated CHF (NYHA classes III-IV). Five patients unresponsive to diuretic treatment underwent a short course of intermittent haemodiafiltration (iHDF), whereas five patients responsive to diuretics were treated with intravenous boluses of furosemide. Renal function was similar between the two groups. Results. Excess body fluids were removed in both groups always resulting in a reduction of pulmonary congestion and peripheral oedema. NYHA class improved in all patients, but one treated by intravenous boluses of furosemide. Only patients treated with iHDF showed a significant reduction of circulating interleukin-8 and monocyte chemoattractant protein-1. After the end of iHDF treatment, patients showed consistent restoration of diuretic responsiveness to significantly lower doses of oral furosemide up to one month of follow-up. Plasma levels of BNP before treatment were significantly higher in the iHDF group, lowering significantly in both groups after treatment. Conclusions. Our results suggest that HDF is an effective treatment for patients with advanced CHF when cytokines have to be cleared and diuretic responsiveness needs to be restored. In our experience, iHDF is a cost-effective option when compared with continuous ultrafiltration methods because it can be performed in a routine dialysis unit without adjunctive costs for machinery or personnel training.

AB - Background. Elevated plasma levels of cytokines have been associated with an increased risk of congestive heart failure (CHF) even in people without history of myocardial infarction. Here we have tested the hypothesis that effective removal of pro-inflammatory cytokines in patients with advanced CHF unresponsive to diuretic treatment is associated with diuresis restoration and with a significant reduction of B-type natriuretic peptide (BNP) circulating levels. Methods. We prospectively enrolled 10 patients with decompensated CHF (NYHA classes III-IV). Five patients unresponsive to diuretic treatment underwent a short course of intermittent haemodiafiltration (iHDF), whereas five patients responsive to diuretics were treated with intravenous boluses of furosemide. Renal function was similar between the two groups. Results. Excess body fluids were removed in both groups always resulting in a reduction of pulmonary congestion and peripheral oedema. NYHA class improved in all patients, but one treated by intravenous boluses of furosemide. Only patients treated with iHDF showed a significant reduction of circulating interleukin-8 and monocyte chemoattractant protein-1. After the end of iHDF treatment, patients showed consistent restoration of diuretic responsiveness to significantly lower doses of oral furosemide up to one month of follow-up. Plasma levels of BNP before treatment were significantly higher in the iHDF group, lowering significantly in both groups after treatment. Conclusions. Our results suggest that HDF is an effective treatment for patients with advanced CHF when cytokines have to be cleared and diuretic responsiveness needs to be restored. In our experience, iHDF is a cost-effective option when compared with continuous ultrafiltration methods because it can be performed in a routine dialysis unit without adjunctive costs for machinery or personnel training.

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