Ultrafiltration for heart failure therapy

Abstract

Heart failure, acute, exacerbated, or chronic activates antidiuresis and results in the regulatory sodium and water retention, mainly within the extracellular compartment. Diuretics remove more water than sodium, which activates thirst. Ultrafiltration in extracorporeal circulation or during peritoneal dialysis removes water and sodium in equal proportions. The results of both treatment methods — using diuretics or ultrafiltration — and their complications are similar, although the extracorporeal ultrafiltration is faster, more favourable to the heart, and for a longer time reduces fluid overload. Unfortunately, ultrafiltration is much more expensive. Thus, it seems reasonable to restrict the use of ultrafiltration to all cases of heart failure refractory to diuretics, and to adjust its rate to the clinical situation. Due to the limited vascular refilling rate one should not remove, depending on the method, more than 6–8 litres of plasma water per day. In chronic heart failure the peritoneal dialysis seems an effective method of preventing heart failure exacerbations and hospitalizations. The same holds true for the repeated, scheduled extracorporeal ultrafiltration treatments.