Document Detail

Technical aspects of extracorporeal ultrafiltration: mechanisms, monitoring and dedicated technology.
MedLine Citation:
PMID:  20428004     Owner:  NLM     Status:  MEDLINE    
Fluid overload may occur in patients with heart failure. Further complications may arise when cardiorenal syndromes develop and the kidneys are unable to eliminate the accumulated fluid. Diuretics represent the fist line of treatment, although in some case they may be ineffective or even dangerous for the patient. In these conditions, extracorporeal ultrafiltration may be required. Extracorporeal ultrafiltration can be performed continuously or intermittently, using dedicated machines. The goal is to remove the right amount of fluid without causing hemodynamic instability or further ischemia to the kidneys. For this purpose, special technologies are available and they can be utilized in combination to prevent iatrogenic complications. First of all, a complete analysis of heart and kidney function should be carried out. Then, an evaluation of biomarkers of heart failure and a careful analysis of body fluid composition by bioimpedance vector analysis should be carried out to establish the level of hydration and to guide fluid removal strategies. Last but not least, an adequate extracorporeal technique should be employed to remove excess fluid. Preference should be given to continuous forms of ultrafiltration (slow continuous ultrafiltration, continuous venovenous hemofiltration); these techniques guided by a continuous monitoring of circulating blood volume allow for an adequate restoration of body fluid composition minimizing hemodynamic complications and worsening of renal function especially during episodes of acute decompensated heart failure.
Federico Nalesso; Francesco Garzotto; Claudio Ronco
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Publication Detail:
Type:  Journal Article; Review     Date:  2010-04-20
Journal Detail:
Title:  Contributions to nephrology     Volume:  164     ISSN:  1662-2782     ISO Abbreviation:  Contrib Nephrol     Publication Date:  2010  
Date Detail:
Created Date:  2010-04-29     Completed Date:  2010-08-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7513582     Medline TA:  Contrib Nephrol     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  199-208     Citation Subset:  IM    
Copyright Information:
Copyright 2010 S. Karger AG, Basel.
Department of Nephrology, Dialysis & Transplantation, International Renal Research Institute, San Bortolo Hospital, Vicenza, Italy.
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MeSH Terms
Biomedical Technology
Heart Failure / therapy*
Hemofiltration / instrumentation,  methods*
Kidney Diseases / therapy*
Monitoring, Physiologic / instrumentation,  methods*
Water-Electrolyte Imbalance / therapy*

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