[Extracorporeal treatment in patients with heart failure: pathophysiology, indications and results]

The removal of oedema by ultrafiltration in patients with severe congestive heart failure (CHF) is associated with significant clinical and hemodynamic improvement, correction of hyponatremia, restoration of urine output and diuretic responsiveness, and with a striking fall in neurohormonal activation. Through these effects, ultrafiltration is able to stop the progression of CHF toward refractoriness, improving the clinical condition of CHF patients to a lower functional class. Fluid refilling from the hyperhydrated interstitium is the main compensatory mechanism allowing the prevention of hypovolemia during ultrafiltration. Ultrafiltration can benefit also those patients affected by moderate cardiac failure (NYHA class III) whose hyperhydration is restricted to the pulmonary area significantly limiting their functional capacity. In this setting, ultrafiltration, unlike diuretics, can remove the increased lung water content and improve clinical condition, exercise capacity and lung function.