clinical evidence
Ultrafiltration Versus Usual Care for
Hospitalized Patients With Heart Failure: The Relief for Acutely
Fluid-Overloaded Patients With Decompensated Congestive Heart Failure
(RAPID-CHF) Trial
Bradley A. Bart, MD, FACC, Andrew Boyle, MD, Alan J. Bank, MD,
FACC, Inder Anand, MD, FACC, Maria Teresa Olivari, MD, FACC, Mark
Kraemer, MD, Shari Mackedanz, RN, BSN, CCRC, Paul A. Sobotka, MD,
FACC, Mike Schollmeyer, DVM, Steven R. Goldsmith, MD, FACC. Minneapolis
and Brooklyn Park, Minnesota
Journal of the American College of Cardiology 2005;46(11):2043–2046
OBJECTIVES: The purpose of this research was
to assess the safety and efficacy of ultrafiltration (UF) in patients
admitted with decompensated congestive heart failure (CHF).
BACKGROUND: Ultrafiltration for CHF is usually
reserved for patients with renal failure or those unresponsive to
pharmacologic management. We performed a randomized trial of UF
versus usual medical care using a simple UF device that does not
require special monitoring or central intravenous access.
METHODS: Patients admitted for CHF with evidence
of volume overload were randomized to a single, 8 h UF session in
addition to usual care or usual care alone. The primary end point
was weight loss 24 h after the time of enrollment.
RESULTS: 40 patients were enrolled (20 UF, 20 usual
care). Ultrafiltration was successful in 18 of the 20 patients in
the UF group. Fluid removal after 24 h was 4,650 ml and 2,838 ml
in the UF and usual care groups, respectively (p=0.001). Weight
loss after 24 h, the primary end point, was 2.5 kg and 1.86 kg in
the UF and usual care groups, respectively (p=0.240). Patients tolerated
UF well.
CONCLUSIONS: The early application of UF for patients
with CHF was feasible, well-tolerated, and resulted in significant
weight loss and fluid removal. A larger trial (UNLOAD) is underway
to determine the relative efficacy of UF versus standard care in
acute decompensated heart failure.
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