Pourafshar Negiin, Karimi Ashkan, Kazory Amir
a Division of Nephrology, Hypertension, and Renal Transplantation , University of Florida , Gainesville , FL , USA.
b Division of Cardiovascular Medicine , University of Florida , Gainesville , FL , USA.
Expert Rev Cardiovasc Ther. 2016;14(1):5-13. doi: 10.1586/14779072.2016.1110020. Epub 2015 Nov 2.
Congestion is the most common reason for hospitalization of patients with acute decompensated heart failure (ADHF) and adversely impacts their outcomes. Extracorporeal ultrafiltration (UF) therapy has re-emerged as an effective strategy for decongestion in this setting. This article is intended to discuss key concepts in UF and its technique, provide a brief historical view of UF application for decongestion in ADHF, review the hemodynamic and neurohormonal effects of UF and their positive effects on the pathophysiology of ADHF, discuss the findings of the landmark trials in this field, and explain key findings of these studies as well as the apparent discrepancies in their findings. In a separate section we discuss the intricacies of renal dysfunction in ADHF as it plays a very important role in understanding the current evidence and designing futures clinical trials of UF in ADHF. In the end, the authors provide their perspective on the future role of UF in management of patients with ADHF and congestion.
充血是急性失代偿性心力衰竭（ADHF）患者住院的最常见原因，并对其预后产生不利影响。体外超滤（UF）治疗已再次成为这种情况下有效的充血消除策略。本文旨在讨论超滤及其技术的关键概念，简要回顾超滤在ADHF充血消除中的应用历史，综述超滤的血流动力学和神经激素效应及其对ADHF病理生理学的积极影响，讨论该领域具有里程碑意义的试验结果，并解释这些研究的关键发现以及它们在结果上明显的差异。在单独的一节中，我们将讨论ADHF中肾功能不全的复杂性，因为它在理解当前证据和设计未来ADHF超滤临床试验方面起着非常重要的作用。最后，作者阐述了超滤在ADHF和充血患者管理中的未来作用。
