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Fluid removal in acute heart failure: diuretics versus devices.

Publication ,  Journal Article
Krishnamoorthy, A; Felker, GM
Published in: Curr Opin Crit Care
October 2014

PURPOSE OF REVIEW: Fluid removal and relief of congestion are central to treatment of acute heart failure. Diuretics have been the decongestive mainstay but their known limitations have led to the exploration of alternative strategies. This review compares diuretics with ultrafiltration and examines the recent evidence evaluating their use. RECENT FINDINGS: Relevant recent studies are the Diuretic Optimization Strategies Evaluation trial (of diuretics) and the Cardiorenal Rescue Study in Acute Decompensated Heart Failure (of ultrafiltration). The Diuretic Optimization Strategies Evaluation study evaluated strategies of loop diuretic use during acute heart failure (continuous infusion versus intermittent bolus and high dose versus low dose). After 72  h, there was no significant difference with either comparison for the coprimary end points. Patients treated with a high-dose strategy tended to have greater diuresis and more decongestion compared with low-dose therapy, at the cost of transient changes in renal function. The Cardiorenal Rescue Study in Acute Decompensated Heart Failure study showed that in acute heart failure patients with persistent congestion and worsening renal function, ultrafiltration, as compared with a medical therapy, was associated with similar weight loss but greater increase in serum creatinine and more adverse events. SUMMARY: Decongestion remains a major challenge in acute heart failure. Although recent studies provide useful data to guide practice, the relatively poor outcomes point to the continued need to identify better strategies for safe and effective decongestion.

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Published In

Curr Opin Crit Care

DOI

EISSN

1531-7072

Publication Date

October 2014

Volume

20

Issue

5

Start / End Page

478 / 483

Location

United States

Related Subject Headings

  • Weight Loss
  • Ultrafiltration
  • Treatment Outcome
  • Practice Guidelines as Topic
  • Infusions, Intravenous
  • Humans
  • Heart Failure
  • Emergency & Critical Care Medicine
  • Diuretics
  • Creatinine
 

Citation

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Krishnamoorthy, A., & Felker, G. M. (2014). Fluid removal in acute heart failure: diuretics versus devices. Curr Opin Crit Care, 20(5), 478–483. https://doi.org/10.1097/MCC.0000000000000134
Krishnamoorthy, Arun, and G Michael Felker. “Fluid removal in acute heart failure: diuretics versus devices.Curr Opin Crit Care 20, no. 5 (October 2014): 478–83. https://doi.org/10.1097/MCC.0000000000000134.
Krishnamoorthy A, Felker GM. Fluid removal in acute heart failure: diuretics versus devices. Curr Opin Crit Care. 2014 Oct;20(5):478–83.
Krishnamoorthy, Arun, and G. Michael Felker. “Fluid removal in acute heart failure: diuretics versus devices.Curr Opin Crit Care, vol. 20, no. 5, Oct. 2014, pp. 478–83. Pubmed, doi:10.1097/MCC.0000000000000134.
Krishnamoorthy A, Felker GM. Fluid removal in acute heart failure: diuretics versus devices. Curr Opin Crit Care. 2014 Oct;20(5):478–483.

Published In

Curr Opin Crit Care

DOI

EISSN

1531-7072

Publication Date

October 2014

Volume

20

Issue

5

Start / End Page

478 / 483

Location

United States

Related Subject Headings

  • Weight Loss
  • Ultrafiltration
  • Treatment Outcome
  • Practice Guidelines as Topic
  • Infusions, Intravenous
  • Humans
  • Heart Failure
  • Emergency & Critical Care Medicine
  • Diuretics
  • Creatinine