MethodsPeripherally inserted veno-venous ultrafiltration for rapid treatment of volume overloaded patients*,**
Section snippets
Study patients
A total of 25 treatments in 21 adult patients (15 men and 6 women, mean age 62.7 ± 16.3 years, mean height 175.6 ± 12.8 cm) with fluid overload were performed at 3 clinical sites. Fluid overload was identified if 2 or more of the following were present: (1) evidence of peripheral edema (≥2+), (2) ascites or enlarged liver, (3) rales one quarter up from base or paroxysmal nocturnal dyspnea or orthopnea, or (4) evidence of sacral edema (≥2+). All patients (n = 21) had a previous history of
Results
Of 25 treatments, 23 (92%) achieved the primary endpoint of greater than 1 L of ultrafiltrate removed, and 19 treatments (76%) removed more than 2 L (Fig. 2).An average of 2611 ± 1002 mL of fluid was removed per treatment.
Discussion
To our knowledge, this is the first clinical report of rapid removal of extracellular and intravascular fluid volume excess via ultrafiltration without use of a central venous catheter. Ultrafiltration resulted in decreases in body weight without changes in vital signs or laboratory parameters.
In this trial, the primary endpoint of greater than 1 L of ultrafiltrate removal in 8 hours or less was achieved in 23 of 25 treatments, or 92%. In both cases in which this was not achieved, venous
Conclusions
In the future, studies may be of interest comparing peripheral ultrafiltration to pharmacologic therapy alone with endpoints of fluid removal, hospital duration, or cost. In this series, 3 patients were treated as outpatients, suggesting that early application could obviate the need for hospitalization in selected patients with volume overload states.
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2018, Advances in Chronic Kidney Disease
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Reprint requests: Brian E. Jaski, MD, San Diego Cardiac Center, 3131 Berger Avenue, San Diego, CA 92123.
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