Ultrafiltration in Decompensated Heart Failure with Cardiorenal Syndrome

• Published in: The New England journal of medicine Vol. 367; no. 24; pp. 2296 - 2304
• Main Authors: Bart, Bradley A, Goldsmith, Steven R, Lee, Kerry L, Givertz, Michael M, O'Connor, Christopher M, Bull, David A, Redfield, Margaret M, Deswal, Anita, Rouleau, Jean L, LeWinter, Martin M, Ofili, Elizabeth O, Stevenson, Lynne W, Semigran, Marc J, Felker, G. Michael, Chen, Horng H, Hernandez, Adrian F, Anstrom, Kevin J, McNulty, Steven E, Velazquez, Eric J, Ibarra, Jenny C, Mascette, Alice M, Braunwald, Eugene
• Format: Journal Article
• Language: English
• Published: Waltham, MA Massachusetts Medical Society 13.12.2012
• Subjects: Aged; Algorithms; Biological and medical sciences; Cardio-Renal Syndrome - etiology; Cardio-Renal Syndrome - therapy; Cardiology. Vascular system; Creatinine - blood; Diuretics - adverse effects; Diuretics - therapeutic use; Drug therapy; Female; General aspects; Heart; Heart failure; Heart Failure - complications; Heart Failure - drug therapy; Heart Failure - mortality; Heart Failure - therapy; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Humans; Infusions, Intravenous; Male; Medical sciences; Middle Aged; Ultrafiltration - adverse effects; Weight Loss - drug effects; Heart failure; Medicine; Cardiovascular disease; Ultrafiltration; Heart disease; Syndrome
• ISSN: 0028-4793; 1533-4406; 1533-4406
• DOI: 10.1056/NEJMoa1210357

Patients with decompensated heart failure and cardiorenal syndrome were randomly assigned to ultrafiltration or diuretic therapy. Ultrafiltration was inferior to diuretics with respect to the primary end point, a bivariate measure of change in creatinine and body weight. The acute cardiorenal syndrome (type 1) is defined as worsening renal function in patients with acute decompensated heart failure. 1 It occurs in 25 to 33% of patients with acute decompensated heart failure and is associated with poor outcomes. 1 , 2 Multiple processes contribute to the development of the acute cardiorenal syndrome, including extrarenal hemodynamic changes, neurohormonal activation, intrarenal microvascular and cellular dysregulation, and oxidative stress. 1 In some cases, intravenous diuretics, which are often administered in patients with acute decompensated heart failure, 3 may directly contribute to worsening renal function. 1 , 4 , 5 The use of diuretics to treat persistent congestion after the onset . . .