Acute decompensated heart failure (ADHF) has the highest rate of hospital re-admission among all medical conditions and portends a significant financial burden on healthcare systems worldwide. Hospitalization for ADHF is primarily driven by congestion, with intravenous loop diuretics representing the cornerstone of therapy. However, it is well described that a significant subset of patients are discharged with residual fluid overload. While the cause of the incomplete decongestion is multifactorial, development of diuretic resistance is a well-characterized contributing factor with consequent poor outcomes. Moreover, the therapeutic response to diuretics is known to lack predictability. Extracorporeal ultrafiltration (a mechanical pump-driven therapy) has emerged as an option to overcome shortcomings of the diuretics. It allows clinicians to customize the volume and rate of fluid removal to the needs and clinical characteristics of the patients. The results of the currently available studies indicate that this therapy is associated with more efficient fluid and sodium removal comparted to medical therapy, hence leading to reduction in the rate of re-admissions and a potential salutary impact on the financial burden associated with the care of these patients. While isolated ultrafiltration can be performed by conventional machines used for renal replacement therapy, the advent of simplified, portable, and user-friendly devices that are specifically designed for extracorporeal ultrafiltration therapy has further enhanced the interest in this therapeutic modality and increased the potential for its more widespread use. Further development in this direction through device miniaturization may extend the horizons of indications and the applicability of this therapy even in the ambulatory settings.


中文翻译：

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急性心力衰竭的体外超滤

急性失代偿性心力衰竭 (ADHF) 在所有疾病中的再入院率最高，预示着全球医疗保健系统将承受巨大的经济负担。ADHF 的住院治疗主要是由充血引起的，静脉内袢利尿剂是治疗的基石。然而，据详细描述，很大一部分患者出院时残留液体超负荷。虽然不完全去充血的原因是多方面的，但利尿剂抵抗的发展是导致不良结果的一个充分表征的促成因素。此外，已知对利尿剂的治疗反应缺乏可预测性。体外超滤（一种机械泵驱动疗法）已成为克服利尿剂缺点的一种选择。它允许临床医生根据患者的需要和临床特征定制液体去除的体积和速率。目前可用的研究结果表明，与药物治疗相比，这种疗法可以更有效地去除液体和钠，从而降低再入院率，并对与护理相关的经济负担产生潜在的有益影响这些病人。虽然孤立超滤可以通过用于肾脏替代治疗的传统机器进行，但专为体外超滤治疗设计的简化、便携和用户友好的设备的出现进一步增强了人们对这种治疗方式的兴趣，并增加了其应用的潜力。更广泛的使用。