| Outcomes of volume-overloaded cardiovascular patients treated with ultrafiltration. | |
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MedLine Citation:
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PMID: 18672200 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Ultrafiltration (UF) can rapidly and predictably remove extracellular and intravascular fluid volume. To date, assessment of UF in patients with cardiovascular disease has been confined to short- and medium-term studies in patients with a principal diagnosis of acute heart failure. METHODS: In-hospital and long-term outcomes were reviewed from consecutive patients with cardiovascular disorders and recognized pulmonary and systemic volume overload treated with a simplified UF system with the capability for peripheral venovenous access. Trained abstractors reviewed both paper and electronic medical records. Patients with a principal diagnosis of heart failure versus other primary hospital discharge diagnoses were identified according to International Classification of Diseases, 9th Revision standards by independent coders. RESULTS: For a period of 43 months, 100 patients (76 male/24 female, 65 +/- 14.0 years of age, systolic dysfunction 64%) were treated with UF during 130 hospitalizations. Baseline systolic blood pressure was 119 +/- 23 mm Hg. Before UF, 53% were receiving intravenous vasoactive therapy. By using UF, 7.1 +/- 3.9 L of ultrafiltrate were removed during 2.0 +/- 1.2 treatments per hospitalization. Baseline creatinine was 1.8 +/- 0.8 and 1.9 +/- 1.2 (not significant) at discharge. Of the 15 in-hospital deaths, 14 occurred during the initial hospitalization. Left ventricular dysfunction was related to 13 (87%) of the 15 deaths; no deaths were related to UF use. In hospitalizations with a principal diagnosis of heart failure (n = 79), in-hospital mortality was 7.6% compared with an ADHERE risk tree estimated mortality of 7.5%. Multivariate logistic regression identified a trend for decreased systolic blood pressure to predict patient initial hospitalization mortality (P = .06). Kaplan-Meier survivals for all patients were 71% at 1 year and 67% at 2 years. Cox regression found decreased systolic blood pressure as a predictor of long-term mortality (P = .025). Total volume of ultrafiltrate removed, ejection fraction, history of coronary artery disease, creatinine clearance, gender, age, and principal diagnosis of heart failure were not significantly associated with long-term mortality. CONCLUSION: This series extends the spectrum of patients previously reported to be treated with UF. Despite marked volume overload, UF-treated patients with a principal diagnosis of heart failure had inpatient outcomes similar to the ADHERE registry. UF should be considered for a broad range of patients who present with volume overload. |
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Authors:
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Brian E Jaski; Andrew Romeo; Bryan Ortiz; Peter M Hoagland; Maureen Stone; Dale Glaser; Lorie Thomas; Cynthia Walsh; Sidney C Smith |
Publication Detail:
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Type: Comparative Study; Journal Article; Research Support, Non-U.S. Gov't Date: 2008-05-27 |
Journal Detail:
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Title: Journal of cardiac failure Volume: 14 ISSN: 1532-8414 ISO Abbreviation: J. Card. Fail. Publication Date: 2008 Aug |
Date Detail:
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Created Date: 2008-08-01 Completed Date: 2009-02-24 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9442138 Medline TA: J Card Fail Country: United States |
Other Details:
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Languages: eng Pagination: 515-20 Citation Subset: IM |
Affiliation:
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San Diego Cardiac Center, Sharp Memorial Hospital, San Diego, California 92123, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Cardiovascular Diseases / mortality*, physiopathology, therapy* Female Heart Failure / mortality, physiopathology, therapy Hemofiltration / methods, trends* Hospital Mortality / trends Humans Male Middle Aged Retrospective Studies Treatment Outcome Ultrafiltration / methods, trends |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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