Fluid Re-Distributing Rather Than Fluid Removal Therapy as a Mainstay of Initial Heart Failure Treatment in Patients With Maintenance Hemodialysis

Background: Some patients under maintenance hemodialysis experience acute heart failure. Diuretic therapy is a mainstay of treatment for acute heart failure, but diuretics are not indicated for most of these patients. Methods: To clarify profile, treatment, and outcome in such patients, we retrospectively analyzed 36 patients (67% men, 72 ± 10 years) under hemodialysis experiencing acute heart failure. Results: Diabetic nephropathy was the most prevalent etiology of their renal impairment (61%) and chronic glomerulonephritis was the next (19%). A mean left ventricular ejection fraction (LVEF) was 45 ± 12% and 39% of patients were categolized as heart failure with preserved ejection fraction (LVEF > 50%). Even though sudden onset (≦6 hours), arrival via ambulance, and off-hours arrival (5 p.m. to 9 a.m.) were frequently observed (in 69%, 92%, and 75% of patients, respectively), only one (3%) patient needed emergent dialysis in off-hours. Most of patients, instead, were successfully treated with vasodilator (97%) and non-invasive positive pressure ventilation (39%), though their urine output was 0 mL for median. Only two (8%) patients underwent diuretic therapy and no patient died during hospitalization. Conclusions: We revealed profile, treatment, and outcome in patients under hemodialysis experiencing acute heart failure. Most of them were successfully treated by fluid re-distributing therapy rather than with fluid removal therapy, and emergent hemodialysis was necessary only in a selected subgroup.