The Present and Future
State-of-the-Art Review
Extracorporeal Ultrafiltration for Fluid Overload in Heart Failure: Current Status and Prospects for Further Research

https://doi.org/10.1016/j.jacc.2017.03.528Get rights and content
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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.

Key Words

biomarkers
creatinine
diuretics
glomerular filtration rate
venous congestion

Abbreviations and Acronyms

NGAL
neutrophil gelatinase-associated lipocalin
UF
ultrafiltration

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Dr. Costanzo served as principal investigator for AVOID-HF trial; has received research support through her institution for the AVOID-HF trial; consultant for Axon Therapies. Columbia University is the assignee for biomarker patents developed by Dr. Barasch. Dr. Fonarow has received funding from National Institutes of Health; and is consultant for Amgen, Janssen, Medtronic, Novartis, and St. Jude Medical. Dr. Gottlieb has received research grants from Amgen and Novartis; and is consultant for Bristol-Myers Squibb. Dr. Levin holds equity in Coridea and Axon Therapies. Dr. Negoianu is a speaker for Gambro Inc./Baxter and Fresenius; and was a member of the Steering Committee for AVOID-HF trial. Dr. Voors has received research grants and consultancy fees from AstraZeneca, Bayer, Bristol-Myers Squibb, Boehringer Ingelheim, Cardio3Biosciences, GlaxoSmithKline, Merck/MSD, Novartis, Servier, Sphingotec, Stealth Peptides, Trevena, and Vifor. Dr. Stough was funded by Coridea, LLC. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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