Ultrafiltration in the treatment of severe congestive heart failure

Background: Fluid removal remains a fundamental goal in the treatment of congestive heart failure (CHF). Vacuum ultrafiltration, hemodialysis, or a combination of both was used in patients with severe CHF (NYHA class IV), severe edema, and insensitivity to pharmacological treatment with diuretics. Methods: The aim of the study was to remove the overload fluid in eighteen patients, 13 men and 5 women, aged 38 to 83, with a man age of 66 years with intractable congestive heart failure. All patients were hospitalized because of severe congestive heart failure and did not respond to treatment with intravenous administration of a high dose of diuretics and positive inotropic agents. They thus underwent vacuum ultrafiltration (1 to 27 sessions) while in 4 of them hemodialysis was also performed because of high serum creatinine levels (over 4 mg/dl). Subclavian catheters were used in all patients and arteriovenous fistula was later performed in 2, because of the need for long term treatment. The average fluid removed was 2 L per session and the total fluid removed ranged from 4 to 29 L. Results: Fourteen of the 18 patients (78%) showed significant improvement in their clinical status. Ten patients (56%) had a short term improvement but expired after 7 to 107 days of hospitalization. Four patients (22%) died after only one session of dialysis and 4 patients (22%) recovered after 8 to 23 dialysis sessions and were discharged from hospital. Conclusion: The majority of patients with severe chronic CHF which is intractable to conventional therapy including intravenous diuretics and inotropes improve by the use of ultrafiltration. However, a limited proportion of them survive to be discharged from the hospital.