Slow isolated ultrafiltration for the treatment of congestive heart failure

Slow isolated ultrafiltration (UF) was used to remove excess water and sodium in refractory congestive heart failure (CHF) patients. Fifty-two patients (40 men, 12 women; age, 63.8 +/- 10.2 years) presenting with CHF (class IV, New York Heart Association (NYHA)) were included in the study. Forty-one patients had normal renal function, and 11 patients had various degrees of renal failure before the episode of cardiac decompensation. Cardiac disease caused by ischemia, hypertension, or a combination was present in the majority of patients (n = 28). UF was performed in all cases via a venovenous modality using a double-pump module (blood and UF pumps) and using highly permeable membrane (AN69; Hospal, Lyon, France). The weight loss achieved by UF to restore dry weight was 9.2 +/- 5.0 kg over 9.0 +/- 10.5 days with satisfactory hemodynamic tolerances. Outcome of the 52 patients was as follows: 13 patients (nonresponders) died during the course of treatment; 24 patients (responders) had both cardiac and renal temporary improvement for a short or long duration period; 15 patients (partial responders) had cardiac improvement and renal degradation leading to long-term treatment (intermittent UF or dialysis). Interestingly, diuresis returned in 24 of 39 responder patients. In conclusion, isolated UF offers a simple and effective means of escape from the cardio-renal vicious circle in refractory CHF patients. UF must be considered as an integral tool for the modern treatment of CHF. (C) 1996 by the National Kidney Foundation, Inc.