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      Extracorporeal Ultrafiltration for the Treatment of Overhydration and Congestive Heart Failure


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          Fluid overload may occur in patients with congestive heart failure. Under normal conditions, this is treated with inotropic support and diuretics. However, when diuretics fail, fluid removal becomes uncontrolled and other therapeutic options must be undertaken. Extracorporeal ultrafiltration is a possible solution to restore a status of fluid balance close to normal. Several new technologies have made ultrafiltration available today in all centers and easy to be instituted. Acute isolated schedules of ultrafiltration may, however, be too aggressive and result in severe hemodynamic instability. For this reason, continuous extracorporeal techniques have been applied in such patients and the therapy is generally carried out with success. Excellent hemodynamic stability, a good cardiovascular response and often diuresis restoration are the most common effects encountered using continuous forms of extracorporeal fluid removal. The potential for a home-based application of these techniques represents a further stimulating concept to be investigated.

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          New Perspectives in the Treatment of Acute Renal Failure

          The evolution of technology and biomaterials has permitted a parallel development of renal replacement therapies in the acute, critically ill patient. From the original description of continuous arterio-venous haemofiltration, new techniques such as continuous veno-venous haemofiltration, haemodiafiltration and high flux dialysis have been developed and clinically utilised. A parallel improvement in efficiency has been achieved with urea daily clearances as high as 50 litres or more. The use of special highly permeable dialysers has also permitted to increase the clearances of larger solutes thus leading to significant removals of chemical substances involved in the acute inflammation and sepsis. In this field, recent observations have suggested to use haemofiltration with high volumes of fluid exchange. The hardware and software of the newer continuous renal replacement therapies (CRRT) are certainly the key point in achieving these results and in safely performing such challenging techniques.

            Author and article information

            S. Karger AG
            18 January 2002
            : 96
            : 3-4
            : 155-168
            aDepartment of Nephrology, St. Bortolo Hospital, Vicenza, Italy; bDepartment of Intensive Care, Austin and Repatriation Medical Center, Heidelberg, Vic., Australia; cDepartment of Interventional Cardiology, Istituto Clinico Sant’Ambrogio, Milan, Italy
            47399 Cardiology 2001;96:155–168
            © 2002 S. Karger AG, Basel

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            Page count
            Figures: 15, Tables: 4, References: 21, Pages: 14


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