Congestive heart failure ultrafiltration

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [2]

Overview

In the setting of congestive heart failure, ultrafiltration has been associated with a reduced incidence of hospitalization compared with diuretics in the UNLOAD trial, but no difference in mortality.

Mechanism

Ultrafiltration removes plasma water from whole blood. Possible benefits of ultrafiltration include:

• Provides fluid regulation

• Relieve pulmonary edema
• Reduce ascites and/or peripheral edema
• Hemodynamic stabilization
• Improve oxygenation
• Facilitates blood product replacement without excess volume
• Enable parenteral nutritional support without excess volume

• Improves solute regulation

• Correct acid-base balance
• Correct serum sodium content
• Eliminate myocardial depressant factors or known toxins
• Correct uremia
• Correct hyperkalemia
• Correct other electrolyte disturbances

• Helps to establish homeostasis

• Reset water omostat
• Restore diuretic responsiveness
• Reduce neurohormonal activation

ACC/AHA Guidelines- Ultrafiltration Recommendation

“

Class IIa 1. Ultrafiltration is reasonable for patients with refractory congestion not responding to medical therapy. (Level of Evidence: B)

”

Vote on and Suggest Revisions to the Current Guidelines

• The CHF Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines

Guidelines Resources

• 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation

• The ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult

References

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