- Erratum in:
- J Am Coll Cardiol. 2007 Mar 13;49(10):1136.
- Comment in:
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Curr Cardiol Rep. 2008 May;10(3):165-6.
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Curr Heart Fail Rep. 2009 Mar;6(1):1-2.
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J Am Coll Cardiol. 2007 Aug 21;50(8):820; author reply 820-1.
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J Am Coll Cardiol. 2007 Feb 13;49(6):684-6.
Ultrafiltration versus intravenous diuretics for patients hospitalized for acute decompensated heart failure.
Costanzo MR,
Guglin ME,
Saltzberg MT,
Jessup ML,
Bart BA,
Teerlink JR,
Jaski BE,
Fang JC,
Feller ED,
Haas GJ,
Anderson AS,
Schollmeyer MP,
Sobotka PA;
UNLOAD Trial Investigators.
Midwest Heart Foundation, Edward Heart Hospital, Lombard, Illinois 60566, USA. mcostanzo@midwestheart.com
OBJECTIVES: This study was designed to compare the safety and efficacy of veno-venous ultrafiltration and standard intravenous diuretic therapy for hypervolemic heart failure (HF) patients. BACKGROUND: Early ultrafiltration may be an alternative to intravenous diuretics in patients with decompensated HF and volume overload. METHODS: Patients hospitalized for HF with > or =2 signs of hypervolemia were randomized to ultrafiltration or intravenous diuretics. Primary end points were weight loss and dyspnea assessment at 48 h after randomization. Secondary end points included net fluid loss at 48 h, functional capacity, HF rehospitalizations, and unscheduled visits in 90 days. Safety end points included changes in renal function, electrolytes, and blood pressure. RESULTS: Two hundred patients (63 +/- 15 years, 69% men, 71% ejection fraction < or =40%) were randomized to ultrafiltration or intravenous diuretics. At 48 h, weight (5.0 +/- 3.1 kg vs. 3.1 +/- 3.5 kg; p = 0.001) and net fluid loss (4.6 vs. 3.3 l; p = 0.001) were greater in the ultrafiltration group. Dyspnea scores were similar. At 90 days, the ultrafiltration group had fewer patients rehospitalized for HF (16 of 89 [18%] vs. 28 of 87 [32%]; p = 0.037), HF rehospitalizations (0.22 +/- 0.54 vs. 0.46 +/- 0.76; p = 0.022), rehospitalization days (1.4 +/- 4.2 vs. 3.8 +/- 8.5; p = 0.022) per patient, and unscheduled visits (14 of 65 [21%] vs. 29 of 66 [44%]; p = 0.009). No serum creatinine differences occurred between groups. Nine deaths occurred in the ultrafiltration group and 11 in the diuretics group. 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. (The UNLOAD trial; http://clinicaltrials.gov/ct/show/NCT00124137?order=1; NCT00124137).
PMID: 17291932 [PubMed - indexed for MEDLINE]