Kamath Sandeep A
Division of Cardiovascular Medicine, University of Virginia Health System, P.O. Box 800158, Charlottesville, VA 22908, USA.
Int J Nephrol. 2010 Oct 19;2011:190230. doi: 10.4061/2011/190230.
Congestion, due in large part to hypervolemia, is the primary driver of heart failure (HF) admissions. Relief of congestion has been traditionally achieved through the use of loop diuretics, but there is increasing concern that these agents, particularly at high doses, may be deleterious in the inpatient setting. In addition, patients with HF and the cardiorenal syndrome (CRS) have diminished response to loop diuretics, making these agents less effective at relieving congestion. Ultrafiltration, a mechanical volume removal strategy, has demonstrated promise in achieving safe and effective volume removal in patients with cardiorenal syndrome and diuretic refractoriness. This paper outlines the rationale for ultrafiltration in CRS and the available evidence regarding its use in patients with HF. At present, the utility of ultrafiltration is restricted to selected populations, but a greater understanding of how this technology impacts HF and CRS may expand its use.
充血在很大程度上归因于血容量过多，是心力衰竭（HF）住院的主要驱动因素。传统上，通过使用袢利尿剂来缓解充血，但人们越来越担心这些药物，尤其是高剂量时，在住院环境中可能有害。此外，心力衰竭和心肾综合征（CRS）患者对袢利尿剂的反应减弱，使得这些药物在缓解充血方面效果较差。超滤是一种机械性的容量清除策略，已显示出在实现心肾综合征和利尿剂抵抗患者安全有效的容量清除方面具有前景。本文概述了CRS中超滤的基本原理以及其在HF患者中应用的现有证据。目前，超滤的效用仅限于特定人群，但对该技术如何影响HF和CRS的更深入了解可能会扩大其应用范围。
