Ultrafiltration, Congestive Heart Failure, & the RAPID-CHF Trial

For patients with fluid overload without severe renal failure, fluid removal via ultrafiltration with peripherally inserted IVs is an alternative to SCUF (slow continuous ultrafiltration) which uses conventional dialysis or hemofiltration machines and requires central IV access. The advantages of ultrafiltration (also called "aquafiltration") include

• peripheral vs. central access
• floor vs. ICU care
• ultrafiltration may be performed by cardiologists and intensivists without needing to call a nephrologist (which potentially, might be a disadvantage to the patient)

CHF Solutions has been aggressively marketing the Aquadex FlexFlow Fluid Removal System which can remove up to half a liter of fluid an hour. Two small studies of ultrafiltration have been published in this month's Journal of the American College of Cardiology. Larger studies are underway. From the Press Release:

A device that performs ultrafiltration of blood, without requiring specialized nursing care or invasive central intravenous access, can reduce fluid overload in patients with congestive heart failure, according to a new study in the Dec. 6, 2005, issue of the Journal of the American College of Cardiology.

"We found that this form of ultrafiltration therapy was safe, effective and successfully applied to patients in a variety of hospital settings. Compared to patients receiving standard treatment with intravenous diuretics, patients undergoing ultrafiltration had more fluid removed in the first 24 and 48 hours and improved symptoms of heart failure and shortness of breath at 48 hours," said Bradley A. Bart, M.D., F.A.C.C., from the Minnesota Heart Failure Consortium in Minneapolis, Minnesota.

Patients admitted to the hospital with acute decompensated heart failure are suffering from symptoms primarily related to fluid build-up and congestion, including swelling around the feet and ankles, bloated abdomens, cough and shortness of breath.

The RAPID-CHF trial is the first randomized controlled trial of ultrafiltration for acute decompensated heart failure. As blood passes through the device, ultrafiltration removes water and some small molecules through a membrane, before the blood is returned to the patient.

Researchers randomly assigned 40 hospitalized patients to receive either usual care, including diuretic medicine in most cases, or a single eight-hour ultrafiltration treatment, in addition to usual care. The ultrafiltration was performed with a device that has been approved by the federal Food and Drug Administration for use outside of intensive care units and without specialized nursing or central intravenous access. The manufacturer of the device, CHF Solutions Inc., funded this study.

Thanks to Clinical Cases and Images for pointing me to the free full-text versions of the articles online.

Technorati Tags: Ultrafiltration, CHF Solutions, Aquafiltration, Heart Failure, Congestive Heart Failure, RAPID-CHF