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Fluid removal in acute heart failure: diuretics versus devices
Arun Krishnamoorthy1, G Michael Felker
1aDivision of Cardiology, Department of Medicine bDuke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA.
Current Opinion in Critical Care
|August 12, 2014
Summary
Diuretics and ultrafiltration are key for acute heart failure decongestion. Recent trials show limited benefits and potential risks, highlighting the need for improved strategies to manage fluid overload safely and effectively.
Area of Science:
- Cardiology
- Nephrology
- Critical Care Medicine
Background:
- Fluid removal is crucial for acute heart failure management.
- Diuretics are standard, but have limitations.
- Alternative decongestion strategies are being explored.
Purpose of the Study:
- To compare diuretics with ultrafiltration in acute heart failure.
- To review recent evidence on their effectiveness and safety.
Main Methods:
- Review of the Diuretic Optimization Strategies Evaluation (DOSE) trial.
- Review of the Cardiorenal Rescue Study in Acute Decompensated Heart Failure (CARRESS-HF).
Main Results:
- DOSE trial: No significant difference between diuretic strategies (continuous vs. intermittent, high vs. low dose) for primary endpoints. High-dose diuretics increased diuresis but transiently affected renal function.
- CARRESS-HF: Ultrafiltration showed similar weight loss but greater increases in serum creatinine and more adverse events compared to medical therapy in patients with persistent congestion and worsening renal function.
Conclusions:
- Decongestion in acute heart failure remains challenging.
- Recent studies offer guidance but indicate a need for better decongestion strategies.
- Improved methods for safe and effective fluid removal are essential.
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