RESUMEN
Introducción y objetivo En la insuficiencia cardíaca la congestión es el síntoma más frecuente y es habitual la resistencia diurética. El objetivo del estudio es analizar si la ultrafiltración (UF) ambulatoria de corta duración por vía periférica es útil y segura en estos pacientes. Material y métodos Se analizaron los 5 primeros pacientes ultrafiltrados por resistencia diurética en una unidad de gestión rápida de un hospital de referencia durante 12h. Resultados Estos pacientes estaban en tratamiento con al menos 3 diuréticos por vía oral; la UF permitió reducir y/o retirar algunos. El volumen extraído durante el procedimiento fue de 1520±271ml. Hubo cambios significativos en la diuresis (pre-UF: 1360±164; post-UF: 1670±254ml; p=0,035); peso (pre-UF: 69,6±14; post-UF: 66,2±15kg; p=0,0001) y creatinina (pre-UF: 2,1±0,3; post-UF: 1,8±0,4mg; p=0,023). Conclusiones En pacientes en régimen ambulatorio con insuficiencia cardíaca y resistencia a los diuréticos, la UF de corta duración por vía periférica resultó efectiva y segura (AU)
Introduction and objective In heart failure congestion is the most common symptom and diuretic resistance is frequent. This study aims to analyse whether short-term peripheral outpatient ultrafiltration (UF) is useful and safe in these patients. Material and methods The first 5 patients ultrafiltrated for diuretic resistance in a fast-track unit of a referral hospital for 12hours were analysed. Results These patients were on treatment with at least 3 oral diuretics; UF made it possible to reduce and/or withdraw some of them. The volume extracted during the procedure was 1520±271ml. There were significant changes in diuresis (PreUF: 1360±164, PostUF: 1670±254ml; P=.035), weight (PreUF: 69.6±14, PostUF: 66.2±15kg; P=.0001) and creatinine (PreUF: 2.1±0.3, PostUF: 1.8±0.4mg; P= 0.023). Conclusions In outpatients with heart failure and diuretic resistance, short-course peripheral UF was effective and safe (AU)
Asunto(s)
Humanos , Masculino , Femenino , Anciano de 80 o más Años , Ultrafiltración/métodos , Diuréticos/administración & dosificación , Insuficiencia Cardíaca/terapia , Resultado del Tratamiento , Estudios RetrospectivosRESUMEN
AIMS: Patients with heart failure (HF) admitted for decompensation often require high doses of intravenous diuretics. This study aims to analyse whether the use of peripheral ultrafiltration (UF) in patients hospitalized for acute HF with systemic-predominant congestion results in better hydric control, renal protection, and reduction of hospital stay compared with conventional treatment. METHODS AND RESULTS: This study was a retrospective, comparative, single-centre study of 56 patients admitted for HF with systemic congestion with a poor diuretic response after diuretic escalation. One group underwent peripheral UF (35 patients) and others were maintained on intense diuretic treatment (control group, 21 patients). The diuretic response and days of hospital stay were compared between and within groups. The baseline characteristics of both groups were similar: males with right ventricular failure and renal dysfunction. The inter-group analysis showed that patients who received UF had better glomerular filtration rate (GFR; UF: 39.2 ± 18.2 vs. control: 28.7 ± 13.4 mL/min; P = 0.031) and higher diuresis (UF: 2184 ± 735 vs. control: 1335 ± 297 mL; P = 0.0001) at hospital discharge despite less need for diuretic drugs. Days of hospital stay were shorter in the UF group (UF: 11.7 ± 10.1 vs. control: 19.1 ± 14.4 days; P = 0.027). Intra-group analysis showed that patients receiving UF improved GFR, increased diuresis, and reduced weight at discharge (P < 0.001), whereas patients on conventional treatment only experienced improved weight but worsening renal function at discharge. CONCLUSIONS: In patients with acute HF with systemic congestion and diuretic resistance, UF compared with conventional treatment produces greater decongestion and renal protection, reduces the total diuretic load, and shortens the length of hospital stay.
Asunto(s)
Insuficiencia Cardíaca , Ultrafiltración , Masculino , Humanos , Ultrafiltración/métodos , Diuréticos/uso terapéutico , Estudios Retrospectivos , Insuficiencia Cardíaca/tratamiento farmacológico , RiñónRESUMEN
INTRODUCTION AND OBJECTIVE: In heart failure congestion is the most common symptom and diuretic resistance is frequent. This study aims to analyse whether short-term peripheral outpatient ultrafiltration (UF) is useful and safe in these patients. MATERIAL AND METHODS: The first 5 patients ultrafiltrated for diuretic resistance in a fast-track unit of a referral hospital for 12hours were analysed. RESULTS: These patients were on treatment with at least 3 oral diuretics; UF made it possible to reduce and/or withdraw some of them. The volume extracted during the procedure was 1520±271ml. There were significant changes in diuresis (PreUF: 1360±164, PostUF: 1670±254ml; P=.035), weight (PreUF: 69.6±14, PostUF: 66.2±15kg; P=.0001) and creatinine (PreUF: 2.1±0.3, PostUF: 1.8±0.4mg; P= 0.023). CONCLUSIONS: In outpatients with heart failure and diuretic resistance, short-course peripheral UF was effective and safe.