What is ultrafiltration in acute decompensated heart failure?

Background: Ultrafiltration is a method used to achieve diuresis in acute decompensated heart failure (ADHF) when there is diuretic resistance, but its efficacy in other settings is unclear. We therefore conducted a systematic review and meta-analysis to evaluate the use of ultrafiltration in ADHF.

Is ultrafiltration better than intravenous diuretic in acute decompensated heart failure patients?

Conclusions. In decompensated HF, ultrafiltration safely produces greater weight and fluid loss than intravenous diuretics, reduces 90-day resource utilization for HF, and is an effective alternative therapy.

Which drug is contraindicated in decompensated heart failure?

Drugs that can exacerbate heart failure should be avoided, such as nonsteroidal anti-inflammatory drugs (NSAIDs), calcium channel blockers (CCBs), and most antiarrhythmic drugs (except class III).

What do you give for decompensated heart failure?

Early intravenous vasodilator therapy with an agent that lowers arterial tone (eg, nitroprusside) is suggested in selected patients with ADHF who require a rapid decrease in systemic vascular resistance and LV afterload (eg, those with severe hypertension, acute mitral regurgitation, or acute aortic regurgitation).

How is Ultrafiltration performed?

Ultrafiltration is done in the hospital because it is important to monitor the speed of fluid removal so that patients can tolerate the procedure safely. During the procedure a small catheter is placed in a vein, usually in the arm. The catheter brings blood to the ultrafiltration machine, and then back to the patient.

What is peripheral ultrafiltration?

Ultrafiltration, a type of renal replacement therapy, is an invasive procedure that creates a transmembrane pressure gradient driving plasma fluid across a semipermeable membrane. This technique can be used as an alternative to diuretic treatment for the removal of excess fluid in volume-overloaded HF patients.

Why don’t you use beta-blockers in decompensated heart failure?

The initiation of beta-blocker therapy during ADHF is contraindicated due to acute negative inotropic effects.

Why can’t you use beta-blockers in acute decompensated heart failure?

Beta‐blockers also reduce sudden cardiac death (SCD).3, 4, 5 The discontinuation of beta‐blockers in patients admitted with acute decompensated heart failure (ADHF) has been reported to be associated with significantly increased in‐hospital and short‐term mortality,7, 8 possibly due to activation of the sympathetic …

When do you stop diuretics in heart failure?

Often physicians will stop active diuresis once the BUN levels begin to rise. The patient’s weight should be measured at this point and be documented as the patients euvolemic (or “dry”) weight. Prior to discharge, the diuretics should be converted from an intravenous to an oral regimen.

What is the first principle of management in patients with acute decompensated heart failure?

Respiratory therapies. In patients with pulmonary edema and hypoxia, the use of supplemental oxygen is recommended. Short-term positive pressure ventilation should be considered first-line treatment of acute cardiogenic pulmonary edema.

Where does the ultrafiltration take place?

the kidneys
In renal physiology, ultrafiltration occurs at the barrier between the blood and the filtrate in the glomerular capsule (Bowman’s capsule) in the kidneys.

What is the purpose of ultrafiltration?

Ultrafiltration (UF) is used to remove essentially all colloidal particles (0.01 to 1.0 microns) from water and some of the largest dissolved contaminants. The pore size in a UF membrane is mainly responsible for determining the type and size of contaminants removed.

How is ultrafiltration performed?

What is removed by ultrafiltration?

Ultrafiltration is the removal of fluid from a patient and is one of the functions of the kidneys that dialysis treatment replaces. Ultrafiltration occurs when fluid passes across a semipermeable membrane (a membrane that allows some substances to pass through but not others) due to a driving pressure.

What should people with acute decompensated heart failure avoid?

Beta-blockers should be avoided in the setting of ADHF when there is evidence for hypoperfusion. Also, calcium channel blockers are not highly recommended due to their negative inotropic properties and their association with worse outcomes.

Why is propranolol contraindicated in heart failure?

It has been controversial that using propranolol in case of heart failure is contraindicated due to its effect on the deterioration of the patient’s hemodynamic status and leading to mortality.

Can diuretics be used with beta-blockers?

Beta-blocker/thiazide diuretic combos lower the blood pressure by removing excess water and salt from the body and slowing the heart rate. These drugs, when given in combination, cause fewer side effects generally caused because of diuretics. Diuretics also boost the blood pressure-lowering effect of the other drug.

Is ultrafiltration effective in the treatment of acute decompensated heart failure?

Little is known about the efficacy and safety of ultrafiltration in patients with acute decompensated heart failure complicated by persistent congestion and worsened renal function.

What is the treatment for diuretic-resistant heart failure (HF)?

Several approaches to treat diuretic-resistant HF are available, including addition of distal acting thiazide diuretics, natriuretic doses of mineralocorticoid receptor antagonists (MRAs), or vasoactive drugs. Slow continuous veno-venous ultrafiltration is another option.

Does decompensated heart failure worsen renal function in hospitalized patients?

In summary, we conducted a randomized trial involving patients hospitalized for acute decompensated heart failure, worsened renal function, and persistent congestion.

Does diuretic dosing affect renal function during ADHF hospitalization?

Of particular interest is the association of higher diuretic dosing with worsening renal function (WRF) during ADHF hospitalization because WRF characterized by changes in creatinine and/or estimated glomerular filtration rate has been shown to be a predictor of poor outcomes (7, 15).