Abstract 1885: Acute Decompensated Heart Failure Treated with Prolonged Ultrafiltration: Perhaps Longer is Better
Background: Ultrafiltration is emerging as a safe and effective means for removing large amounts of extra-cellular fluid from hospitalized patients with acute decompensated heart failure. The recently presented “Ultrafiltration vs IV Diuretics for Patients Hospitalized for Acute Decompensated CHF trial” (UNLOAD Trial) demonstrated superior volume removal as well as a reduction in readmissions for heart failure in patients treated with ultrafiltration compared with standard intravenous diuretic therapy. In our analysis we looked at prolonged ultrafiltration (>24 hours) in hospitalized patients with severe decompensated heart failure (NYHA IV).
Methods: The patients were maintained on the ultrafiltration device (Aquadex FlexFlow by CHF Solutions) for 46±710 hours with an average rate of fluid removal of 380 cc/hour.
Results: A total of 8 patients received ultrafiltration with 3 patient receiving the treatment twice. The average volume removed was 12 ±3 liters without a significant change in renal function as outlined in table 1⇓. The baseline ejection fraction was 33±15% and the baseline dose of Lasix prior to ultrafiltration was 126±73 mg/day. There was also a trend towards a reduction in hospitalizations for heart failure among patients treated with ultrafiltration
Inferences: Overall there was a dramatic improvement in quality of life and a substantial removal of volume without obvious renal impairment in patients treated with ultrafiltration for prolonged periods. This investigation would suggest that ultrafiltration can be used safely for large volume fluid removal and may play a role in decongesting patients with decompensated heart failure