Extracorporeal veno-venous ultrafiltration in congestive heart failure: What’s the state of the art? A mini-review

Table 1 Differences between ultrafiltration and diuretics

Loop diuretics	Isolated ultrafiltration
Hypotonic urine	Isotonic plasma water
Direct neurohormonal activation	No direct neurohormonal activation
Unpredictable elimination of sodium and water	Precise control of rate and amount of fluid removal
Diuretic resistance	Restoration of diuretic responsiveness
Hypokalemia and hypomagnesemia	No effect on plasma concentration of potassium and magnesium
No need for anticoagulation	Need for anticoagulation
No extracorporeal circuit	Need for extracorporeal circuit

Table 2 Overview of most relevant randomized controlled trials on ultrafiltration-based decongestive therapy

RCTs	Target population	UF device	Primary and secondary endpoint	Results
RAPID-CHF (2005)	ADHF, n = 40	Aquadex system, 8-h course	Weight loss at 24 h of treatment (Primary endpoint); Volume removal after 24 h	Weight reduction resulted not statistically significant (P = 0.24); Volume removal was significantly more in UF arm (P < 0.001)
UNLOAD (2007)	ADHF, n = 200	Aquadex System, Mean fluid removal rate 241 mL/h	Weight loss at 48 h; Dyspnea score at 48 h	Weight loss resulted significantly increased in UF arm (P < 0.001), whereas there were no differences between groups in Dyspnea score (P = 0.588)
ULTRADISCO (2011)	ADHF, n = 30	PRISMA, treatment duration 46 h	Changes in hemodynamics assessed using PRAM: SVi, CI, CPO, SVR were measured during hospitalization, at discharge, and at 1 and 3-mo follow-up	UF arm as compare to standard care had a significant improvement of global hemodynamic status
CARRESS-HF (2012)	ADHF, n = 188; Recent increase in serum creatinin >/= 0.3 mg/dL	Aquadex System at a fixed rate of 200 mL/h	Bivariate changes in sCr and change in weight 96 h after randomization
CUORE (2014)	ADHF, LVEF </=40%, n = 56	Dedyca system	HF rehospitalization at 1 yr	UF arm has a significant lower endpoint incidence (P = 0.002)
AVOID-HF (2016)	ADHF, n = 224	Aquadex system at an ajdusted rate on a per protocol established basis	Time to first HF event (HF rehospitalization or unscheduled outpatient or emergency treatment with intravenous loop diuretic agents or UF) within 90 days of hospital discharge	30-d HF rehospitalizations: 11 of 2876 (UF arm) vs 24 of 2882 (diuretics arm), P = 0.06
Hu et al[49], 2021	ADHF, n = 100	FQ-16 type HF ultrafiltration dehydration device (Beijing Hartcare Medical Technology Co., Ltd)	Weight loss and an increase in urine output on days 4 and 8 of treatment; Secondary outcome evaluated: BNP, NYHA class, IVC collapse index, JVP	Early ultrafiltration group had a significantly greater weight loss (P < 0.001) than the torasemide + tolvaptan group and urine increase (P < 0.001); Secondary outcomes that were followed up demonstated a clear trend towards benefits of UF as compared to diuretics arm

ADHF: Acutely decompensated heart failure; BNP: Brain natriuretic peptide; CI: Cardiac index; CPO: Cardiac power output; IVC: Inferior vena cava; JVP: Jugular venous pressure; HF: Heart failure; NYHA: New York Heart association; PRAM: Pressure Recording Analytical Method; sCr: Serum creatinine; SVi: Stroke volume indexed; SVR: Systemic vascular resistance; UF: Ultrafiltration; RCT: Randomized clinical trial.