Gologorsky Rebecca C, Roy Shuvo
Department of Surgery, University of California, San Francisco-East Bay, Oakland, California.
Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, California.
Artif Organs. 2020 Feb;44(2):129-139. doi: 10.1111/aor.13549. Epub 2019 Aug 26.
Heart failure is the number one cause of death in the United States and a significant burden to the healthcare system. One of the primary complications of heart failure is fluid overload, for which current treatments are limited. Medical therapy is first-line; however, rates of diuretic insensitivity are high, medications are not easily titrated, and they do not address the underlying physiologic derangement that leads to hypervolemia. Removal of isotonic fluid via hemofiltration and peritoneal dialysis is an understudied but promising therapy that enables decongestion without maladaptive stimulation of fluid retention pathways. Published studies report conflicting data on long-term outcomes of ultrafiltration but reach consensus on greater and more durable volume reduction with ultrafiltration than conventional medical therapy. These studies are noteworthy for their neglect to standardize both patient selection and fluid removal protocol, which likely contribute to outcome variation. Novel technology in preclinical testing includes implantable ultrafiltration, which has potential to treat volume overload while minimizing the adverse effects associated with conventional hemofiltration. We performed a literature review of English-language studies on hemo- and peritoneal filtration for management of fluid overload in congestive heart failure. Also included is a discussion of the pathophysiology of congestive heart failure and first-line management as well as emerging technologies for ultrafiltration.
心力衰竭是美国头号死因，也是医疗保健系统的重大负担。心力衰竭的主要并发症之一是液体超负荷，目前针对这一情况的治疗方法有限。药物治疗是一线治疗方法；然而，利尿剂不敏感率很高，药物剂量不易调整，而且它们无法解决导致血容量过多的潜在生理紊乱问题。通过血液滤过和腹膜透析去除等渗液是一种研究较少但很有前景的治疗方法，它能够实现去充血，而不会对液体潴留途径产生适应性不良刺激。已发表的研究报告了关于超滤长期结果的相互矛盾的数据，但对于超滤比传统药物治疗能实现更大程度和更持久的容量减少这一点达成了共识。这些研究因忽视了患者选择和液体去除方案的标准化而值得关注，这可能导致了结果的差异。临床前测试中的新技术包括可植入式超滤，它有潜力治疗容量超负荷，同时将与传统血液滤过相关的不良反应降至最低。我们对关于血液滤过和腹膜滤过治疗充血性心力衰竭液体超负荷的英文研究进行了文献综述。此外，还讨论了充血性心力衰竭的病理生理学、一线治疗方法以及超滤的新兴技术。
