The mainstay of acute CHF exacerbation is removing the excess fluid from the patient via diuresis with loop diuretics, like Lasix.Diuretics have been used to treat fluid overload for over 50 years but they have adverse metabolic effects (hypokalemia, stimulation of renin-angiotensin system) and do not work very well in patients with advanced chronic kidney disease.
Fluid removal via ultrafiltration in a new approach for treating CHF exacerbation. Ultrafiltration (also called "aquafiltration") can be done via peripheral line and on a regular medical floor. Commercially available devices can remove 500 cc of fluid per hour.
The RAPID-CHF trial is the first RCT of ultrafiltration for acute decompensated heart failure. The trial included just 40 patients which were randomized to receive either usual care (diuretic) or a single eight-hour ultrafiltration, in addition to usual care.
18 from the 20 patients undergoing ultrafiltration had more fluid removed and improved symptoms of heart failure and shortness of breath at 48 hours.
You can download the 2 ultrafiltration studies and the editorial from the ACC website (free full text, published in the 12/6/05 issue of the Journal of the American College of Cardiology).
Ultrafiltration makes physiological sense for CHF treatment but a larger trial is needed to prove its safety and efficacy. The two studies discussed here are just small pilot trials and definitive studies are in progress.
References:
Ultrafiltration, Congestive Heart Failure, & the RAPID-CHF Trial - KidneyNotes.com
The System 100 - CHF Solutions, Inc.
Less-Invasive Ultrafiltration Device May Be Practical Alternative to Diuretics - ACC News Release
Ultrafiltration May Be Practical Alternative to Diuretics - MedGadget
Image source: Wikipedia
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