A Randomized, Controlled Trial of the Renal Effects of Ultrafiltration as Compared to Furosemide in Patients With Acute Decompensated Heart Failure

Rogers, Hobart L.; Marshall, Joanne; Bock, Jeremy; Dowling, Thomas C.; Feller, Erika; Robinson, Shawn; Gottlieb, Stephen S.

doi:10.1016/j.cardfail.2007.09.007

« Previous Next »Journal of Cardiac Failure
Volume 14, Issue 1 , Pages 1-5, February 2008

A Randomized, Controlled Trial of the Renal Effects of Ultrafiltration as Compared to Furosemide in Patients With Acute Decompensated Heart Failure

Hobart L. Rogers, PharmD
- University of Maryland School of Pharmacy, Baltimore, Maryland
Joanne Marshall, BSN
- University of Maryland School of Medicine, Baltimore, Maryland
Jeremy Bock, MD
- University of Maryland School of Medicine, Baltimore, Maryland
Thomas C. Dowling, PharmD, PhD
- University of Maryland School of Pharmacy, Baltimore, Maryland
Erika Feller, MD
- University of Maryland School of Medicine, Baltimore, Maryland
Shawn Robinson, MD
- University of Maryland School of Medicine, Baltimore, Maryland
Stephen S. Gottlieb, MD
- University of Maryland School of Medicine, Baltimore, Maryland
- Baltimore Veterans Administration Medical Center, Baltimore, Maryland
- Reprint requests: Stephen Gottlieb, MD, Division of Cardiology, University of Maryland Medical Systems, 22 S. Greene St., Baltimore, MD 21201.

Received 20 June 2007; received in revised form 2 August 2007; accepted 8 September 2007. published online 03 January 2008.

Abstract

Objectives

This study was designed to evaluate the consequences of ultrafiltration (UF) and standard intravenous diuretic (furosemide) therapy on glomerular filtration rate (GFR) and renal plasma flow in patients with acute decompensated heart failure.

Background

It has been hypothesized that treatment with diuretics may worsen renal function as the result of systemic neurohormonal activation and direct renal vascular effects. UF also removes fluid, but its actions on intrarenal hemodynamics, and therefore renal function, are unknown.

Methods

Patients hospitalized for acute decompensated heart failure with an ejection fraction less than 40% and two or more signs of hypervolemia were randomized to receive UF or intravenous diuretics. Urine output, GFR (as measured by iothalamate), and renal plasma flow (as measured by para-aminohippurate) were assessed before fluid removal and after 48 hours.

Results

Nineteen patients (59 ± 16 years, 68% were male) were randomized to receive UF (n = 9) or intravenous diuretics (n = 10). The change in GFR (−3.4 ± 7.7 mL/min vs. −3.6 ± 11.5 mL/min; P = .966), renal plasma flow (26.6 ± 62.7 mL/min vs. 16.1 ± 42.0 mL/min; P = .669), and filtration fraction (−6.9 ± 13.6 mL/min vs. −3.9 ± 13.6 mL/min; P = .644) after treatment were not significantly different between the UF and furosemide treatment groups, respectively. There was no significant difference in net 48-hour fluid removal between the groups (−3211 ± 2345 mL for UF and −2725 ± 2330 mL for furosemide, P = .682). UF removed 3666 ± 2402 mL. Urine output during 48 hours was significantly greater in the furosemide group (5786 ± 2587 mL) compared with the UF group (2286 ± 915 mL, P < .001).

Conclusions

During a 48-hour period, UF did not cause any significant differences in renal hemodynamics compared with the standard treatment of intravenous diuretics.

Key Words: Diuresis, renal function