Ultrafiltration in patients with decompensated heart failure and diuretic resistance: an Asian centre's experience

Singapore Med J. 2016 Jul;57(7):378-83. doi: 10.11622/smedj.2016014. Epub 2016 Jan 15.

Abstract

Introduction: Diuretics are the mainstay of therapy for restoring the euvolaemic state in patients with decompensated heart failure. However, diuretic resistance remains a challenge.

Methods: We conducted a retrospective cohort study to examine the efficacy and safety of ultrafiltration (UF) in 44 hospitalised patients who had decompensated heart failure and diuretic resistance between October 2011 and July 2013.

Results: Among the 44 patients, 18 received UF (i.e. UF group), while 26 received diuretics (i.e. standard care group). After 48 hours, the UF group achieved lower urine output (1,355 mL vs. 3,815 mL, p = 0.0003), greater fluid loss (5,058 mL vs. 1,915 mL, p < 0.0001) and greater weight loss (5.0 kg vs. 1.0 kg, p < 0.0001) than the standard care group. The UF group also had a shorter duration of hospitalisation (5.0 days vs. 9.5 days, p = 0.0010). There were no differences in the incidence of 30-day emergency department visits and rehospitalisations for heart failure between the two groups. At 90 days, the UF group had fewer emergency department visits (0.2 vs. 0.8, p = 0.0500) and fewer rehospitalisations for heart failure (0.3 vs. 1.0, p = 0.0442). Reduction in EQ-5D™ scores was greater in the UF group, both at discharge (2.7 vs. 1.4, p = 0.0283) and 30 days (2.5 vs. 0.3, p = 0.0033). No adverse events were reported with UF.

Conclusion: UF is an effective and safe treatment that can improve the health outcomes of Asian patients with decompensated heart failure and diuretic resistance.

Keywords: Asia; diuretic resistance; efficacy and safety; heart failure; ultrafiltration.

MeSH terms

  • Aged
  • Diuretics / therapeutic use*
  • Drug Resistance
  • Emergency Service, Hospital
  • Female
  • Heart Failure / therapy*
  • Hospitalization
  • Humans
  • Male
  • Middle Aged
  • Patient Readmission
  • Retrospective Studies
  • Treatment Outcome
  • Ultrafiltration*

Substances

  • Diuretics