Ultrafiltration For Congestive Heart Failure With Diuretic Resistance

BackgroundHeart failure(HF)is a common and serious disease in China,and fluid retention is one of its main symptoms.Intravenous diuretics are considered the primary means of clearing fluid retention,and its effectiveness decreases with the progression of heart failure,with a high incidence of diuretic insensitivity or diuretic resistance.In heart failure patients with diuretic resistance,the removal of isotonic fluid by ultrafiltration is an effective treatment option,while drug therapy is not effective in removing fluid retention.However,ultrafiltration technology is still in its infancy in China.For patients with congestive heart failure with diuretic resistance,the efficacy and safety of ultrafiltration therapy are still controversial and need to be further verified and summarized.ObjectiveTo evaluate the safety and efficacy of ultrafiltration(UF)therapy for congestive heart failure combined with diuretic resistance by comparison with Diuretic therapy(DIUR-T).MethodsA total of 84 patients with symptomatic congestive heart failure complicated with diuretic resistance who were hospitalized in the First Affiliated Hospital of Xinxiang Medical University from January 2019 to February 2020 were selected.UF group(n=42)and DIUR-T group(n=42)were divided into 1:1.UF group was treated with a special ultrafiltration dehydration device to remove fluid retention and reduce cardiac preload,while DIUR-T group was treated with increased diuretic dosage according to patients’ urine volume.The safety of ultrafiltration was evaluated by observing the serum creatinine,hemoglobin,platelets,bleeding events and renal failure after treatment.The primary endpoint of the study was negative water yield(negative water yield = total water yield-total water intake)during hospitalization,and its validity was evaluated by analyzing negative water yield before discharge.Patients in both groups were followed for at least 1 year after discharge,and the secondary endpoints included cardiovascular death,first emergency department visit or hospitalization for worsening heart failure due to fluid overload.ResultsBefore discharge,the median negative water yield of UF group(6024 m L)was significantly higher than that of DIUR-T group(2633 ml)(P<0.001),the hematocrit(HCT)in UF group(0.31±0.11)was higher than that in DIUR-T group(0.24±0.03)(P<0.001),and the level of N-terminal pro-B-type natriuretic peptide(NT-pro BNP)and in UF group(8450ng/L)was lower than that in DIUR-T group(11000ng/L)(P<0.001).The incidence of cardiovascular death within 1 year in the UF group(14cases,33.33%)was lower than that in DIUR-T group(16 cases,38.10%),but there was no statistical difference(P=0.648).The rate of heart failure rehospitalization in the 90-day UF group(7 cases,16.67%)was significantly lower than that in the DIUR-T group(15 cases,35.71%)(P=0.04).With in 1 year,the rate of heart failure readmission in the UF group(10 cases,23.81%)was lower than that in the DIUR-T group(16 cases,38.10%),but there was no statistical difference(P=0.156).There was no significant difference in creatinine between the two groups before discharge.The incidence of renal failure and bleeding events was similar in both groups.ConclusionUltrafiltration is safe and effective in patients with fluid retention and diuretic resistance in congestive heart failure.