Journal of Shanghai Jiao Tong University (Medical Science) >

2021 , Vol. 41 >Issue 3: 344 - 349

DOI: https://doi.org/10.3969/j.issn.1674-8115.2021.03.010

Clinical research

Efficacy of early ultrafiltration in acute decompensated heart failure patients with volume overload

  • Qian-li WAN ,
  • Jing-yi HU ,
  • Jun ZHOU ,
  • Miao-miao LI ,
  • Yue ZHANG ,
  • Fang YUAN
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  • Department of Cardiology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, China

Received date: 2020-05-15

  Online published: 2021-04-06

Supported by

Shanghai Changning District Characteristic Subject of Acute Heart Failure(20162002)

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Abstract

Objective

·To investigate the efficacy and safety of early ultrafiltration in acute decompensated heart failure (ADHF) patients with volume overload.

Methods

·One hundred patients with ADHF admitted to cardiac care unit of Tongren Hospital, Shanghai Jiao Tong University School of Medicine from July 2018 to September 2019 were randomly divided into early ultrafiltration group (n=40) and diuretic group (n=60). In the early ultrafiltration group, blood ultrafiltration was performed within 3 d after admission,and diuretic sequential treatment (Torasemide 20?40 mg/d and Tolvaptan 7.5?30.0 mg/d) was given on day 4 to 7. The diuretic group received intensive treatment (Torasemide 20?40 mg/d and Tolvaptan 7.5?30.0 mg/d) after admission. On the 4th and 8th day of treatment, the body mass and urine volume of the two groups were compared; on the 8th day, dyspnea score, internal diameter of inferior vena cava (ICV), inferior vena cava-collapse index (IVC-CI), jugular vein pressure (JVP) and B-type natriuretic peptide (BNP) were compared between the two groups. The readmission rate and mortality of the two groups at 1-month and 3-month follow-up were compared. The heart rate, respiratory rate, blood pressure, serum sodium, serum potassium and serum creatinine levels of the two group on the 8th day of treatment were compared with those before treatment, respectively.

Results

·Compared with the diuretic group, weight loss and urine increase in the early ultrafiltration group on the 4th day and the 8th day showed significant difference (all P<0.05). There were significant differences in the changes of dyspnea score, IVC, IVC-CI, JVP and BNP on the 8th day of treatment between the two groups (all P<0.05). No significant differences were found in the safety indexes in the two groups, and the readmission rate and mortality rate in the two groups at 1-month and 3-month follow-up.

Conclusion

·Early ultrafiltration can effectively remove excess body fluids, reduce body weight, increase the sensitivity of patients to diuretics. It has no effect on blood pressure, electrolytes and renal function.

Key words： early ultrafiltration; heart failure; fluid overload; loop diuretics; sequential therapy

Cite this article

Qian-li WAN , Jing-yi HU , Jun ZHOU , Miao-miao LI , Yue ZHANG , Fang YUAN . Efficacy of early ultrafiltration in acute decompensated heart failure patients with volume overload[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2021 , 41(3) : 344 -349 . DOI: 10.3969/j.issn.1674-8115.2021.03.010

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