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Extracorporeal ultrafiltration in refractory heart failure

Lilyana Mircheva, Yoto Yotov, Atanas Angelov, Antoniya Kisheva, Orlin Kunchev, Vera Sirakova


Heart failure (HF) is a major health and social problem and despite the advances in medicine it still remains the main cause for hospitalizations in the developed world. The main sign of decompensation is hypervolemia, which in refractory HF is difficult to treat with the currently available medications. This review studies in detail ultrafiltration (UF) as a safe, effective and promising method for management of refractory congestive HF. The procedure, the prominent clinical studies in this field, as well as the main indications and contraindications are described.


heart failure; hypervolemia; ultrafiltration

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Adams KF, Fonarow GC, Emerman CL, et al., Characteristics and outcomes of patients hospitalized for heart failure in the US: Rationale, design, and preliminary observations from the first 100,000 cases in the Acute Decompensated Heart Failure National Registry (ADHERE). Am Heart J, 2005; 149:209–216.

Аrnold JM, Howlett JG, Dorian P, et al. Canadian Cardiovascular Society Consensus Conference recommendations on heart failure update 2007: prevention, management during intercurrent illness or acute decompensation, and use of biomarkers. Can J Cardiol 2007; 23:21-45.

3. Bart BA, Boyle A, Bank AJ, 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: 2043-2046.

4. Costanzo M.R. Ultrafiltration in the management of heart failure. US Cardiology 2008; 5(1): 66-69

5. Costanzo MR, Guglin ME, Saltzberg MT, et al. Ultrafiltration versus intravenous diuretics for patients hospitalized for acute decompensated heart failure. J Am Coll Cardiol 2007; 49: 675-683.

6. Costanzo MR, Saltzberg M, O’Sullivan J, et al. Early ultrafiltration in patients with decompensated heart failure and diuretic resistance. J Am Coll Cardiol 2005; 46: 2047-51.

7. Felker G.M. Diuretic management in heart failure. Congest Heart Fail 2010; 16(4) (Suppl 1): S68–S72

8. Gerhardt RE, Abdullah AM, Mach SJ, et al. Isolated ultrafiltration in the treatment of refractory congestive heart failure. Arch Intern Med 1979; 139: 358-359.

9. Giglioli C., Landi D, Gensini GF, Valente S, Cecchi E, Scolletta S, Chiostri M, Romano SM. Cardiac efficiency improvement after slow continuous ultrafiltration is assessed by beat –to-beat minimally invasive monitoring in congestive heart failure patients: a preliminary report. Blood Purif 2010; 1: 44-51

10. Giglioli C, Landi D, Cecchi E, Chiostri M. 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- 346.

11. Hunt SA, Abraham WT, Chin MH, et al. ACC/ AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation 2005; 112: e154-e235.

12. Jaski BE, Ha J, Denys BG, et al. Peripherally-inserted veno-venous ultrafiltration for rapid treatment of volume overloaded patients. J Card Fail 2003; 9: 227-31.

13. Kazory A., Ross E.A., Ultrafiltration for decompensated Heart Failure: renal implications. Heart 2009; 95: 1047-1051

Kazory A, Ross EA. Contemporary trends in the pharmacologic and extracorporeal management of heart failure: a nephrologic perspective. Circulation 2008; 117: 975-83.

Kazory A, Ejaz AA, Ross EA. The UNLOAD trial: a “nephrologic” standpoint. J Am Coll Cardiol 2007; 50: 820.

Swedberg K, Clelalnd J, Dargie H, et al. Guidelines for the diagnosis and treatment of chronic heart failure: executive summary (update 2005): the Task Force for the Diagnosis and Treatment of Chronic Heart Failure of the European Society of Cardiology. Eur Heart J 2005; 26: 1115-1140.

Silverstein ME, Ford CA, Lysaght MJ, et al. Treatment of severe fluid overload by ultrafiltration. N Engl J Med 1974; 291: 747-751.

Rogers HL, Marshall J, Bock J, et al. A randomized, controlled trial of the renal effect of ultrafiltration as compared to furosemide in patients with acute decompensated heart failure. J Card Fail 2008; 14:1-5.



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