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Article
Decongestive treatment of acute decompensated heart failure: Cardiorenal implications of ultrafiltration and diuretics
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  • Benjamin Freda, MD, Baystate Health
  • Mara Slawsky, MD, Baystate Health
  • Jaya Mallidi, MD, Baystate Health
  • Gregory Braden, MD, Baystate Health
Document Type
Article, Peer-reviewed
Publication Date
12-1-2011
Abstract
In patients with acute decompensated heart failure (ADHF), treatment aimed at adequate decongestion of the volume overloaded state is essential. Despite diuretic therapy, many patients remain volume overloaded and symptomatic. In addition, adverse effects related to diuretic treatment are common, including worsening kidney function and electrolyte disturbances. The development of decreased kidney function during treatment affects the response to diuretic therapy and is associated with important clinical outcomes, including mortality. The occurrence of diuretic resistance and the morbidity and mortality associated with diuretic therapy has stimulated interest to develop effective and safe treatment strategies that maximize decongestion and minimize decreased kidney function. During the last few decades, extracorporeal ultrafiltration has been used to remove fluid from diuretic-refractory hypervolemic patients. Recent clinical studies using user-friendly machines have suggested that ultrafiltration may be highly effective for decongesting patients with ADHF. Many questions remain regarding the comparative impact of diuretics and ultrafiltration on important clinical outcomes and adverse effects, including decreased kidney function. This article serves as a summary of key clinical studies addressing these points. The overall goal is to assist practicing clinicians who are contemplating the use of ultrafiltration for a patient with ADHF. Copyright © 2011 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.
Publication ISSN
0090-4481
Citation Information
Freda BJ, Slawsky M, Mallidi J, Braden GL. Decongestive treatment of acute decompensated heart failure: Cardiorenal implications of ultrafiltration and diuretics Am J Kidney Dis 2011 Dec;58(6):1005-17.