Two new studies, published in the Dec. 6, 2005 issue of Journal of the American College of Cardiology, have documented safety and efficacy of blood ultrafiltration therapy, a procedure that reduces fluid overload in patients with congestive heart failure. According to the American College of Cardiology, the procedure that in the past was reserved only as a rescue therapy, can now be administered by hospital RN outside the setting of the intensive care unit. It does not require an invasive central IV line, and, as shown by the RAPID-CHF trial (see below), can be used as an early treatment:
Patients admitted to the hospital with acute decompensated heart failure are suffering from symptoms primarily related to fluid build-up and congestion, including swelling around the feet and ankles, bloated abdomens, cough and shortness of breath.
The RAPID-CHF trial is the first randomized controlled trial of ultrafiltration for acute decompensated heart failure. As blood passes through the device, ultrafiltration removes water and some small molecules through a membrane, before the blood is returned to the patient.
Researchers randomly assigned 40 hospitalized patients to receive either usual care, including diuretic medicine in most cases, or a single eight-hour ultrafiltration treatment, in addition to usual care. The ultrafiltration was performed with a device that has been approved by the federal Food and Drug Administration for use outside of intensive care units and without specialized nursing or central intravenous access. The manufacturer of the device, CHF Solutions Inc., funded this study.
Ultrafiltration was successful in 18 of the 20 patients in the group. After 24 hours, an average of 4,650 milliliters of fluid had been removed from patients in the ultrafiltration group, compared to 2,838 ml among patients usual care group. Patients in the ultrafiltration group also lost more weight on average, 2.5 kilograms compared to 1.86 kg average for the usual care group. However, the difference was not statistically significant. Intravenous access was unsuccessful in one patient, and one patient could not be treated due to inability to withdraw blood from the catheter.
Diuretics have been used to treat fluid overload for over 50 years; but the drugs drain electrolytes from patients, including potassium and magnesium, and it can be difficult to determine the proper dose for each patient. A practical, safe and effective ultrafiltration device could be an attractive alternative to diuretics.
To find more about Aquadex™ FlexFlow™ Console (pictured above), an ultrafiltration device from CHF Solutions, Inc. of Minnesota, go to the company’s website…
More thoughts at KidneyNotes.com
American College of Cardiology press release…
Study #1 (.pdf) at Journal of the American College of Cardiology…
Study #2 (.pdf)…
The editorial (.pdf) at Journal of the American College of Cardiology…
(hat tip: Clinical Cases and Images)