Division of Nephrology, Hypertension, and Renal Transplantation, University of Florida, Gainesville, Florida.
Clin J Am Soc Nephrol. 2013 Oct;8(10):1816-28. doi: 10.2215/CJN.02910313. Epub 2013 May 30.
Heart failure remains the leading cause of hospitalization in older patients and is considered a growing public health problem with a significant financial burden on the health care system. The suboptimal efficacy and safety profile of diuretic-based therapeutic regimens coupled with unsatisfactory results of the studies on novel pharmacologic agents have positioned ultrafiltration on the forefront as an appealing therapeutic option for patients with acute decompensated heart failure (ADHF). In recent years, substantial interest in the use of ultrafiltration has been generated due to the advent of dedicated portable devices and promising results of trials focusing both on mechanistic and clinical aspects of this therapeutic modality. This article briefly reviews the proposed benefits of ultrafiltration therapy in the setting of ADHF and summarizes the major findings of the currently available studies in this field. The results of more recent trials on cardiorenal syndrome that present a counterpoint to previous observations and highlight certain limitations of ultrafiltration therapy are then discussed, followed by identification of major challenges and unanswered questions that could potentially hinder its more widespread use. Future studies are warranted to shed light on less well characterized aspects of ultrafiltration therapy and to further define its role in ADHF and cardiorenal syndrome.
心力衰竭仍然是老年患者住院的主要原因，被认为是一个日益严重的公共卫生问题，给医疗保健系统带来了巨大的经济负担。基于利尿剂的治疗方案疗效和安全性不理想，新型药物的研究结果也不尽如人意，这使得超滤技术成为急性失代偿性心力衰竭（ADHF）患者极具吸引力的治疗选择。近年来，由于专用便携式设备的出现以及针对该治疗方式的机制和临床方面的试验取得了有希望的结果，人们对超滤的应用产生了浓厚的兴趣。本文简要回顾了 ADHF 中超滤治疗的预期益处，并总结了该领域现有研究的主要发现。然后讨论了最近关于心肾综合征的试验结果，这些结果与之前的观察结果形成了对比，并强调了超滤治疗的某些局限性，随后确定了可能阻碍其更广泛应用的主要挑战和未解决的问题。未来的研究需要阐明超滤治疗中不太为人所知的方面，并进一步确定其在 ADHF 和心肾综合征中的作用。
