Podsumowanie

U chorych z niewydolnością serca ultrafiltracja powinna być stosowana głównie w celu zmniejszenia przewodnienia jako uzupełniająca opcja terapeutyczna, natomiast w żadnym razie nie alternatywa dla terapii lekami moczopędnymi. Odpowiedzi oczekują pytania o konkretne wskazania do zabiegu ultrafiltracji. Poszukując jednoznacznych dowodów, uważa się, że takie leczenie powinno być zarezerwowane do sytuacji ewidentnej oporności na leczenie farmakologiczne, gdy pacjenci mają dodatni bilans wodny mimo ograniczenia podaży płynów, soli i optymalnej terapii diuretykami (maksymalne bezpieczne dawki, ciągły wlew dożylny, sekwencyjna blokada nefronów przez różne klasy diuretyków). Warto podkreślić, że w niewydolności serca oporność na diuretyki przebiega często z oligurią, narastającą niewydolnością nerek, hiperkaliemią i kwasicą metaboliczną, co oznacza, że chory może wymagać zastosowania innych metod terapii nerkozastępczej zarówno ciągłej, jak i przerywanej (hemodializa, hemofiltracja, hemodiafiltracja, dializa otrzewnowa).

Piśmiennictwo

1. Dickstein K, Cohen-Solal A, Filippatos G, et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the diagnosis and treatment of acute and chronic heart failure 2008 of the European Society of Cardiology. Eur J Heart Fail 2008; 10: 933-989.

2. Adams KF, Fonarow GC, Emerman CL, et al. Characteristics and outcomes of patients hospitalized for heart failure in the United States: rationale, design, and preliminary observations from the first 100000 cases in the Acute Decompensated Heart Failure National Registry (ADHERE). Am Heart J 2005; 149: 209-216.

3. Cleland JG, Swedberg K, Follath F, et al. The EuroHeart failure survey programme - a survey on the quality of care among patients with heart failure in Europe. Part 1: patient characteristics and diagnosis. Eur Heart J 2003; 24: 442-463.

4. Fonarow GC, Stough WG, Abraham WT, et al. Characteristics, treatments, and outcomes of patients with preserved systolic function hospitalized for heart failure. A report from the OPTIMIZE-HF registry. J Am Coll Cardiol 2007; 50: 768-777.

5. Bonow RO, Mann DL, Zipes DP, et al (red.). Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. Saunders 2012.

6. Reinglas J, Haddad H, Davies RA, et al. Cardiorenal syndrome and heart failure. Curr Opin Cardiol 2010; 25: 141-147.

7. Haas GJ, Pestritto V, Abraham W. Ultrafiltration for volume control in decompensated heart failure. Heart Fail Clin 2008; 4: 519-534.

8. Załęska-Kocięcka M, Konopka A. Przednerkowa niewydolność nerek – częsty problem w oddziałach intensywnej terapii kardiologicznej. Kard po Dypl 2011; 10: 51-63.

9. Gheorghiade M, Filippatos G, De Luca L, et al. Congestion in acute heart failure syndromes: an essential target of evaluation and treatment. Am J Med 2006; 119 (12 Suppl 1): S3-S10.

10. Costanzo MR, Jessup M. Treatment of congestion in heart failure with diuretics and extracorporeal therapies: effects on symptoms, renal function, and prognosis Heart Fail Rev 2011; 29: 505-511.

11. Chiong JR, Cheung RJ. Loop diuretic therapy in heart failure: the need for solid evidence on a fluid issue. Clin Cardiol 2010; 33: 345-352.

12. Felker GM. Diuretic Management in Heart Failure. Congest Heart Fail 2010; 16 (Suppl. 1): S68-S72.

13. Mielniczuk LM, Haddad H, Davies RA. Ultrafiltration in the management of acute decompensated heart failure. Curr Opin Cardiol 2010; 25: 155-160.

14. Kazory A, Ross EA. Contemporary trends in the pharmacological and extracorporeal management of heart failure. A nephrological perspective. Circulation 2008; 117: 975-983.

15. Dahle TG, Sobotka PA, Boyle AJ. A practical guide for ultrafiltration in acute decompensated heart failure. Congest Heart Fail 2008; 14: 83-88.

16. Marenzi G, Lauri G, Grazi M, et al. Circulatory response to fluid overload removal by extracorporeal ultrafiltration in refractory congestive heart failure. J Am Coll Cardiol 2001; 38: 963-968.

17. Fauchald P, Forfang K, Amlie J. An evaluation of ultrafiltration as treatment of therapy-resistant cardiac edema. Acta Med Scand 1986; 219 (1): 47-52.

18. Marenzi GC, Grazi S, Giraldi F, et al. Interaction of humeral factors, hemodynamics, and fluid and salt metabolism in congestive heart failure: effects of extracorporeal ultrafiltration. Am J Med 1993; 94: 49-56.

19. Agostoni PG, Marenzi GC, Pepi M, et al. Isolated ultrafiltration in moderate congestive heart failure. J Am Coll Cardiol 1993; 21: 424-431.

20. Agostoni PG, Marenzi GC, Lauri G, et al. Sustained improvement in functional capacity after removal of body fluid with isolated ultrafiltration in chronic cardiac insufficiency: failure of furosemide to provide the same result. Am J Med 1994; 96: 191-199.

21. Ali SS, Olinger CC, Sobotka PA, et al. Loop diuretics can cause clinical natriuretic failure: a prescription for volume expansion. Congest Heart Fail 2009; 15: 1-4.

22. Constanzo MR, Guglin ME, Saltzberg MT, et al. UNLOAD trial investigators. Ultrafiltration versus intravenous diuretics for patients hospitalized for acute decompensated heart failure. J Am Coll Cardiol 2007; 49: 675-683.

23. Bart BA, Boyle A, Bank AJ, et al. Ultrafiltration versus usual care for hospitalized patients with heart failure. The Relief for Acutely Fluid-Overloaded Patients with Decompensated Congestive Heart Failure (RAPID-CHF) Trial. J Am Coll Cardiol 2005; 46: 2043-2046.

24. Giglioli C, Landi D, Cecchi E, et al. Effects of ULTRAfiltration vs DIureticS on clinical, biohumoral and haemodynamic variables in patients with deCOmpensated heart failure: the ULTRADISCO study. Eur J Heart Fail 2011; 13: 337-346.

25. CARdiorenal REScue Study in Acute Decompensated Heart Failure: CARRESS http://www.healthetreatment.com/clinical-trial/NCT00608491/

26. Fiaccadori E, Regolisti G, Maggiore U, et al. Ultrafiltration in heart failure. Am Heart J 2011; 161: 439-49.

27. Freda BJ, Slawasky M, Mallidi J. Decongestive treatment of acute decompensated heart failure: cardiorenal implications of ultrafiltration and diuretics. Am J Kidney Dis 2011; 58: 1005-1017.

28. Kazory A, Ejaz AA, Ross EA. Ultrafiltration for heart failure: how fast should we move? Am Heart J 2009; 157: 205-507.

29. Arnold JM, Howlett JG, Dorian P, et al. Canadian cardiovascular society consensus conference recommendations on heart failure update 2007: prevention, management during intercurrent illness or acute decompensation, and use of biomarkers. Can J Cardiol 2007; 23: 21-45.

30. Hunt SA, Abraham WT, Chin MH, et al. 2009 Focused update incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association task force of practice guidelines – developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation 2009; 119: e391-e479.

31. http://aquadex.gambro.com/en/aquadez/Our-therapy/Whos it For/

32. Human T. Current therapeutic options for hyponatremia: indications, limitations, and confounding variables. Pharmacotherapy 2011; 31 (5 Suppl): 18S-24S.

33. Kazory A, Bellamy FB, Ross EA. Ultrafiltration for acute decompensated heart failure: Financial implications. Int J Cardiol 2011 [ogłoszone on-line przed publikacją].

34. Costanzo MR. Ultrafiltration in the management of heart failure. Curr Opin Crit Care 2008; 230: 524-530.

35. Mehrotra R, Khanna R. Peritoneal ultrafiltration for chronic congestive heart failure: rationale, evidence and future. Cardiology 2001; 96: 177-182.

36. Gotloib L, Fudin R, Yakubovich M, et al. Peritoneal dialysis in refractory end-stage congestive heart failure: a challenge facing a nowin situation. Nephrol Dial Transplant 2005; 20 (Suppl. 7): 32-36.

37. Kagan A, Rapoport J. The role of peritoneal dialysis in the treatment of refractory heart failure. Nephrol Dial Transplant 2005; 20 (Suppl. 7): 28-31.

38. Olszowska A, Próchnicka A, Żelichowski G, et al. Ultrafiltracja jako alternatywna metoda leczenia zastoinowej niewydolności serca opornej na diuretyki. Nefrol Dial Pol 2010; 14: 77-80.

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