clinical evidence
Early Ultrafiltration in Patients With
Decompensated Heart Failure and Diuretic Resistance (EUPHORIA) Trial
Maria Rosa Costanzo, MD, FACC, Mitchell Saltzberg, MD, FACC, Jeanne
O’Sullivan, RN, Paul Sobotka, MD, FACC. Lombard, Illinois;
and Brooklyn Park, Minnesota
Journal of the American College of Cardiology 2005;46(11):2047–51
OBJECTIVES: We sought to determine if ultrafiltration
before intravenous (IV) diuretics in patients with decompensated
heart failure and diuretic resistance results in euvolemia and early
discharge without hypotension or worsening renal function.
BACKGROUND: Heart failure patients with renal insufficiency
and diuretic resistance have increased hospital mortality and length
of stay. Peripheral veno-venous ultrafiltration may re-establish
euvolemia and diuretic responsiveness.
METHODS: Ultrafiltration was initiated within 4.7
± 3.5 h of hospitalization and before IV diuretics in 20
heart failure patients with volume overload and diuretic resistance
(age 74.5 ± 8.2 years; 75% ischemic disease; ejection fraction
31 ± 15%) and continued until euvolemia. Reevaluation was
each hospital day, at 30 days, and at 90 days.
RESULTS: A total of 8,654 ± 4,205 ml were removed
with ultrafiltration. Twelve patients (60%) were discharged in ≤
3 days. One patient was readmitted in 30 days. Weight (p=0.006),
Minnesota Living with Heart Failure scores (p=0.003), and Global
Assessment (p=0.00003) improved after ultrafiltration and at 30
and 90 days. Median B-type natriuretic peptide levels decreased
after ultrafiltration (from 1,230 pg/ml to 788 pg/ml) and at 30
days (815 pg/ml) (p=0.035). Blood pressure, renal function, and
medications were unchanged.
CONCLUSIONS: In heart failure patients with volume
overload and diuretic resistance, ultrafiltration before IV diuretics
effectively and safely decreases length of stay and readmissions.
Clinical benefits persist at three months.
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