Direct comparison of ultrafiltration to pharmacological decongestion in heart failure: a per-protocol analysis of CARRESS-HF

European Journal of Heart Failure
Justin L GrodinW H Wilson Tang

Abstract

Mechanical ultrafiltration (UF) involves the removal of an iso-osmotic filtrate from the blood. Its benefit in acute decompensated heart failure, however, remains inconclusive. We sought to better understand the direct effects of UF in comparison to an aggressive, urine output-guided pharmacological protocol for decongestion on fluid loss, renal function, and neurohormonal activation. A per-protocol analysis of the Cardiorenal Rescue Study in Acute Decompensated Heart Failure (CARRESS-HF) trial (n = 188) was performed. Participants were included if randomized to UF and had UF output collected, or if randomized to the pharmacological arm and had urine but not UF output collected. Using these definitions, there were 163 participants at 24 h, 156 at 48 h, 129 at 72 h, and 106 at 96 h. UF was associated with higher cumulative fluid loss (P = 0.003), net fluid loss (P = 0.001), and relative reduction in weight (P = 0.02). UF was also associated with higher serum creatinine and blood urea nitrogen by 72 h (P-interaction <0.05 for both), lower serum sodium by 48 h (P-interaction <0.01) and increased plasma renin activity by 96 h (P = 0.04). The pharmacological arm was associated with higher serum bicarbonate after 24 h (P-interaction ...Continue Reading

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Citations

May 4, 2018·European Journal of Heart Failure·Abhilash Koratala
Jul 31, 2019·Artificial Organs·Rebecca C Gologorsky, Shuvo Roy
Mar 9, 2019·Cardiac Failure Review·Maria Rosa Costanzo
Nov 28, 2019·Journal of Cardiovascular Translational Research·Navin K KapurRichard H Karas
Sep 2, 2020·Journal of Nephrology·Giacomo DeferrariEdoardo La Porta
Jan 31, 2020·ESC Heart Failure·Daniela TomasoniMarco Metra
Sep 11, 2020·Current Cardiology Reports·W H Wilson Tang, Alan Kiang
Apr 20, 2018·European Journal of Heart Failure·Maria Rosa Costanzo, Amir Kazory
Aug 31, 2019·European Journal of Heart Failure·Andrew J Stewart Coats
Mar 13, 2021·American Journal of Cardiovascular Drugs : Drugs, Devices, and Other Interventions·Saif AliDmitry Abramov
Mar 7, 2020·Revista clínica española·J M Fernández RodríguezA Conde-Martel
Jul 23, 2021·Nefrología : publicación oficial de la Sociedad Española Nefrologia·Rafael de la EspriellaJulio Núñez
May 18, 2021·Revista Clínica Espanõla·J M Fernández RodríguezA Conde-Martel

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