INTRODUCTION. Congestive Acute Heart Failure (C-AHF) is characterized by extracellular fluid overload. Extensive use of loop diuretics may induce worsening renal function, electrolyte imbalance, symptomatic hypotension and diuretic resistance. Extracorporeal veno-venous ultrafiltration (UF) may represent a useful adjunctive therapy. Despite a few randomized clinical trials have been carried out, the results are controversial; aim of this study is to describe our pilot experience using UF.
METHODS. We enrolled consecutive patients with C-AHF refractory to diuretic therapy treated with UF from January to December 2022; patients affected by concomitant acute coronary syndrome were excluded. UF was delivered using a modern device specifically designed for fluid removal in C-AHF patients through slow continuous UF (Fig.1). According to our protocol, the initial UF rate was based on baseline systolic arterial pressure (250cc/h if>120mmHg, 100-120cc/h if 100-120mmHg and <100cc/h if<100mmHg; contra-indicated if<90mmHg). Laboratories values, urinary output and fluid balance were monitored at baseline, after 6 hours (T6) and when UF was stopped (T0). Variables are expressed as medians with 25p-75p.
RESULTS. Seven patients were enrolled in the study (5M;2F); in each a femoral central venous catheter (20cm/14G) was placed to perform UF. A standard anticoagulation regimen based on UFH bolus + infusion was adopted aiming to an ACT of 180-220. Median age and LVEF were respectively 40[20-50] and 79[73-85]; 3 patients were diabetics, 2 smokers and 4 hypertensive. Median rate of hospitalization in the previous 12 months was 1 [0-2]; domiciliary dosage of furosemide was 75mg [50-125]. Baseline, T6h and T0 creatinine values were respectively 1.2 [1.1-2], 1.3 [1.1-1.8] and 1.4 [1.1-1.9]. Heart rate and blood pressure were stable during the treatment. UF parameters in the patients of the study are summarized in Tab.1; congestion was resolved or improved in 6/7 patients, no severe complication (bleeding, AKI, death) occurred while 1 premature filter clot is reported.
CONCLUSIONS. Our initial experience with UF is promising. Modern heart failure specific devices appear safe, easy to use and require only minimal training. Compared to extensive i.v. diuretic use, predictable fluid removal through UF may be beneficial as it is characterized by higher excretion of sodium, limited neuro-hormonal activation, enhanced spontaneous diuresis and restoration of diuretic response.