Therapeutic approach in heart failure with poor diuretic response: peripheral ultrafiltration vs. conventional treatment

• Published in: ESC Heart Failure Vol. 10; no. 4; pp. 2290 - 2297
• Main Authors: López‐Vilella, Raquel, Guerrero Cervera, Borja, Sánchez‐Lázaro, Ignacio, Donoso Trenado, Víctor, Soldevila Orient, Amparo, Devesa Such, Ramón, Martínez Dolz, Luis, Sánchez Pérez, Pilar, Almenar Bonet, Luis
• Format: Journal Article
• Language: English
• Published: England John Wiley & Sons, Inc 01.08.2023; John Wiley and Sons Inc; Wiley
• Subjects: Acute heart failure; Anticoagulants; Antigens; Cardiology; Cardiomyopathy; Chronic obstructive pulmonary disease; Congestion; Diabetes; Diuretics; Diuretics - therapeutic use; Drug dosages; Ejection fraction; Heart failure; Heart Failure - drug therapy; Hospital stay; Humans; Hydric control; Hypertension; Ischemia; Kidney; Male; Original; Patients; Peptides; Peripheral ultrafiltration; Renal protection; Retrospective Studies; Statistical analysis; Student's t-test; Ultrafiltration - methods; Hydric control; Congestion; Renal protection; Peripheral ultrafiltration; Acute heart failure; Hospital stay
• ISSN: 2055-5822; 2055-5822
• DOI: 10.1002/ehf2.14386

Aims Patients with heart failure (HF) admitted for decompensation often require high doses of intravenous diuretics. This study aims to analyse whether the use of peripheral ultrafiltration (UF) in patients hospitalized for acute HF with systemic‐predominant congestion results in better hydric control, renal protection, and reduction of hospital stay compared with conventional treatment. Methods and results This study was a retrospective, comparative, single‐centre study of 56 patients admitted for HF with systemic congestion with a poor diuretic response after diuretic escalation. One group underwent peripheral UF (35 patients) and others were maintained on intense diuretic treatment (control group, 21 patients). The diuretic response and days of hospital stay were compared between and within groups. The baseline characteristics of both groups were similar: males with right ventricular failure and renal dysfunction. The inter‐group analysis showed that patients who received UF had better glomerular filtration rate (GFR; UF: 39.2 ± 18.2 vs. control: 28.7 ± 13.4 mL/min; P = 0.031) and higher diuresis (UF: 2184 ± 735 vs. control: 1335 ± 297 mL; P = 0.0001) at hospital discharge despite less need for diuretic drugs. Days of hospital stay were shorter in the UF group (UF: 11.7 ± 10.1 vs. control: 19.1 ± 14.4 days; P = 0.027). Intra‐group analysis showed that patients receiving UF improved GFR, increased diuresis, and reduced weight at discharge (P < 0.001), whereas patients on conventional treatment only experienced improved weight but worsening renal function at discharge. Conclusions In patients with acute HF with systemic congestion and diuretic resistance, UF compared with conventional treatment produces greater decongestion and renal protection, reduces the total diuretic load, and shortens the length of hospital stay.