TRIALS AND TRIBULATIONS OF SLOW CONTINUOUS ULTRAFILTRATION FOR MANAGEMENT OF ACUTE HEART FAILURE - AN UPDATE FOR 2018 (Invited Lecture)
Amir Kazory, M.D. , University of Florida, Gainesville, FL, USA
Heart failure remains a major public health concern because of its high prevalence, morbidity, mortality, and financial burden. The great majority of patients with heart failure are admitted to the hospital for manifestations related to fluid overload. The poor clinical outcomes associated with acute heart failure, suboptimal efficacy and safety profile of conventional treatment regimens, and unsatisfactory experiences with the newer classes of pharmacologic therapy underlie the interest in the use of slow continuous ultrafiltration in this setting. Besides, the advent of newer technologies associated with user-friendly portable devices that are dedicated to ultrafiltration in heart failure has the potential to overcome several technical and practical issues. In this talk, selected mechanistic aspects of ultrafiltration therapy are briefly reviewed followed by a critical overview of the largest trials in this field to update the audience on the currently available data related to the use of slow continuous ultrafiltration in the setting of acute heart failure. A conceivable implication of the ultrafiltration trials is that collaborative heart failure programs that encompass nephrology and cardiology expertise and resources could improve the outcomes and reduce the cost. Finally, a number of practical recommendations (e.g., customization of ultrafiltration rates) are provided.