Ten Year Experience With Ultrafiltration For The Management of Acute Decompensated Heart Failure

Background Randomized control trials (RCT) of ultrafiltration (UF) have demonstrated conflicting results regarding its efficacy and safety. We reviewed 10 years of real world data regarding UF during hospitalization for ADHF. Methods and Results We performed a retrospective, single center analysis of 335 consecutive patients treated with adjustable rate UF using the CHF Solutions Aquadex Flex Flo System from 7/28/2009 to 6/30/2019. UF for all patients was managed solely by the HF service. Compared to previous RCTs investigating UF, our cohort was older, with worse renal function, and more antecedent HF hospitalizations in the year preceding therapy. Patient characteristics were as follows: mean age 73, 57% male, 48% LVEF Conclusions Compared with previous trials with UF (UNLOAD, CARRESS and AVOID), our real world experience demonstrates that UF compares favorably for HF re-hospitalizations, renal function response, and weight /volume loss. Our cohort was sicker than those studied in clinical trials. Importantly, our real world experience allowed for the adjustment of UF rate during therapy, and we believe this to be a major contributor to our favorable outcomes. In clinical practice, UF can be a safe and effective strategy for decongestion.