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      Extracorporeal Ultrafiltration for the Treatment of Overhydration and Congestive Heart Failure

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          Abstract

          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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          Most cited references 1

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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.
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            Author and article information

            Journal
            CRD
            Cardiology
            10.1159/issn.0008-6312
            Cardiology
            S. Karger AG
            978-3-8055-7380-1
            978-3-318-00820-3
            0008-6312
            1421-9751
            2001
            2001
            18 January 2002
            : 96
            : 3-4
            : 155-168
            Affiliations
            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
            Article
            47399 Cardiology 2001;96:155–168
            10.1159/000047399
            11805382
            © 2002 S. Karger AG, Basel

            Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

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