Efficacy and cardiovascular tolerability of continuous veno-venous hemodiafiltration in acute decompensated heart failure: A randomized comparative study

Background and Objectives: Recently, continuous veno-venous hemodiafiltration (CVVHDF) has received increased attention in the treatment of congestive heart failure (CHF). The aim of this study is to assess the safety and efficacy of CVVHDF compared with intravenous furosemide in patients with CHF. Methods: Forty patients having CHF were included in this prospective, randomized, comparative trial. We randomized patients to treatment for 72 hours with CVVHDF or intravenous furosemide. Outcomes assessed were weight loss, total fluid output, length of stay (LOS) in the intensive care unit (ICU), 30-day mortality, and cardiovascular stability. Results: Demographic data were comparable in both groups. Weight loss (P <= .05) and total fluid output (P <= .01) were greater in the CVVHDF group. Length of stay in the ICU was significantly reduced in the CVVHDF group (P <= .05). The mortality rates were comparable in both groups. The cardiac output and the stroke volume significantly increased, whereas the pulmonary capillary wedge pressure significantly decreased (P <= .05) in both groups compared with the baseline. A transient attack of hypotension occurred in 1 patient in the CVVHDF group. Conclusion: In CHF, the use of CVVHDF effectively and safely produced greater weight and fluid loss and decreased LOS in the ICU more than the intravenous furosemide with no hemodynamic instability. (C) 2012 Elsevier Inc. All rights reserved.