Rate of UF removal, ml/hour (minimum, maximum) 0-500 0-1000 60-500 Anti-coagulation 10-20 units/kg of heparin given IV, single dose A heparin pump provides accurate continuous anticoagulation 10-20 units/kg of heparin given IV, single dose Maximum treatment time, hours 8 48 48
Na+; ↑UNa+ from 26 ±10 to 92 ± 38 mEq/L; ↑ UO despite ↓ Fur. dose from 289±241 to ≈ 40 mg/d DiLeo 1988 (20) Obs. 19 9/10 NR IV Extreme CM, Pl cong, anasarca Polysulfone Amicon filter 17 A-V; 2 PD 125 Rx, 114 hosp., 11 amb./ 14 d/ avg 1,7 to 3.5 L per Rx sCr. 1.6/2.7 7-970 d ↓ Wt. From 75 ± 11 to 68± 11 Kg (p < 0.01) mean Fl loss: 11 L ↓ edema in 17/19; correction of hypoNa+ 5/19; ↑ diuresis 12/19 3 extracorporeal circuit clotting, 5/7 deaths from prog. HF, 2 pneumonias Akiba 1989 (21) Resp. vs. 18 10/8 NR NR NR NR NR 47 ±25 d calc calc Resp. 4 6 dead; Non-Resp. 7 dead calc NR Cipolla 1990 (22) Obs. 23 13/10 NR 4 III, 19 IV Dyspnea at rest, CM, PrE, XR Pl cong, 6 Pl eff. D20SF Amicon Diaf. NR Rx cont. until RAP 4-8 mmHg and Hct > 50% 24 h BUN=125± 75, sCr. 2.3 ± 1.2 mg/dl; UO= 967 ml 24 h post Rx Resolution of all sx. of cong. ↓ RAP and Wt. UO + 606, 967, and 616 ml and UNa+ 52, 68, 63 mEq/L at 0, 1, 2 d; ↓ NE and PRA No Change 5 pts. oliguria Pepi 1993 (23) Randomized UF vs. SC 24 11/13 100% ?NR HF stable D20SF Amicon diafilter (Danvers, Massachusetts)/Gambro AK 10 UF 600 ml/h Single Rx cont. RAP 50% of bsl, Avg. UF vol. NR 90 d UF vs. SC: ↑ Peak VO2, Ex. Time, and ↓ Lung water index, which persisted at 3 mos.; NR NR Resp
1926 ± 760 Improved diast fx. Canaud 1998 (10) Retrospective 52 19/33 100% IV ↑ C/T, CM, PlE BSM-22 Hospal, Lyon, Fr. SCUF, ?SDUF SCUF x 72 h, SDUF 4-8 h/d 35 pts with oliguria (UO < 500ml/d); 17 pts UO 800-1500ml/d M wt loss 9.3 ± 5.0 Kg in 9 ± 10.5 d; ↑natriuresis from 30 to 55 mmol/d; 24 improved both cardiac (CXR and Echo) and fx.( 6 for ≤ 3 mos, 18 for > 3 mos, 8 recurrent HF) 15 Partial resp. : improved cardiac fx. But progression to ESRD req. RRT; 13 Non-Resp died ≤ 1 mo In 35 Surv. ↓ BUN from 33 ± 14 to 31 ±13 mg/dl and sCr from 417± 332 to 306 ± 189 mmol/l BP stability req. adj. of UF rates, inotropes, IV saline For additional information, readers are referred to references (5,7,24,25), which are other studies investigating extracorporeal fluid using early ultrafiltration devices (data from these studies are not summarized in the table) Supplemental Table 3. Pilot Studies with Contemporary Ultrafiltration Systems Author/Y Type No. of Pts. Etiology of HF (Isch./NI) LVEF < 40% NYHA Sx. & Symptoms of HF Membrane/Pump UF Removed Baseline /Post-Rx BUN/sCr (mg/dL) Duration of F/U Outcomes
Costanzo/2005 (26) Single-arm, open label 20 75% ischemic 31 ± 15% (range 10% to 65%) IV: 39% Peripheral edema: 80% Ascites: 95% Rales: 65% PND: 75%: JVD: 95% Sacral edema: 35% Max rate 500 cc/hr, reduced to 200 cc/hr if SBP ≤80 mmHg BUN Baseline: 53 ± 18 Discharge : 54 ± 20 30 days : 59 ± 23 90 days : 58± 28 SCr Baseline : 2.12 ± 0.6 Discharge : 2.20 ± 0.8 30 days : 2.38 ± 1.1 90 days : 58 ± 28 90 days NYHA class IV: 30 days: 1 (5%) 90 days: 2 (11%) Hospitalizations: 3 months prior to UF: 10 hospitalizations in 9 patients 30 days: 1 hospitalization for heart failure Liang/2006 (27) Single-arm, open label 11 System 100 Goal: 4 L removal per 8 hour UF session; 32 treatments in 11 patients Baseline SCr: 2.2 mg/dL Baseline eGFR: 38 mL/min Increase in SCr ≥0.3 mg/dL: 5 (45%) Dialysis for persistent diuretic resistant volume overload or uremic symptoms: 5 (45%) Six mortality: 55% Fluid removal achieved: >3500 mL: 13 (41%) 2500-3500 mL: 11 (34%) <2500 mL: 8 (25%) Aborted due to hypotension: 1 (3%)