Aquapheresis: A New Treatment for Heart Failure (Part 2)
Saturday, June 09, 2007
Joshua Schwimmer, MD, FACP, FASN
In Part 1, I introduced the problem of heart failure and the use of intravenous diuretics, the standard therapy to treat fluid overload in hospitalized patients.Recently, the UNLOAD trial was published in the Journal of the American College of Cardiology. This study compared intravenous diuretics with aquapheresis, a new treatment for heart failure.
Aquapheresis -- also called ultrafiltration -- is a technique for removing excess fluid from the body. It involves the placement of an catheter in the bloodstream that continuously runs the patient's blood through a filter. Excess fluid is remove from the blood through this filter, and the blood is then returned to the patient. Up to half a liter an hour of extra fluid can be precisely removed from the body in this way. (This technique is different than dialysis, which also involves the removal of excess toxins from the body -- using the process of diffusion -- when the kidneys have failed.)
In the UNLOAD trial, two hundred patients with heart failure were randomized to receive either intravenous diuretics or aquapheresis/ultrafiltration. After 48 hours, patients receiving aquapheresis had the following results:
- 38 % greater weight loss over standard care
- 28 % greater net fluid loss over standard care
- Equal improvement in dyspnea score (breathing)
- 43% reduction in patients requiring re-hospitalizations for heart failure over standard care
- 50% reduction in the total number of re-hospitalizations for heart failure over standard care
- 52% reduction in emergency department or clinic visits over standard care
- 63% total reduction in days re-hospitalized for heart failure over standard care
Labels: aquadex flexflow, aquapheresis, cardiology, chf solutions, congestive heart failure, unload trial
9 Comments:
At Thu Jun 14, 09:13:00 PM 2007,
Anonymous said…
What So.Calif.hospitals are utilizing this aquapheresis?
At Sat Jun 16, 06:52:00 AM 2007,
Joshua Schwimmer, MD, FACP, FASN said…
I'm not certain. Anyone from California want to comment?
At Sun Jun 17, 03:05:00 PM 2007,
geena said…
While I don't doubt the long-term (90 day) benefits of this therapy, think about the time involved.
When the doctor decides that he wants to use aquapheresis on a patient, I *assume* that this is what has to happen:
A vascular catheter must be placed in a large vein (again, I'm assuming).
Obtaining consent and filling out consent form for catheter placement: 5 mins
Gathering supplies: 5 mins. 10 if it has to be delivered from central supply.
Looking for the ultrasound machine so the doc can use it to find the vein: 5-10 mins.
Inserting the catheter: 20 mins
Getting trained personnel in to run the aquapheresis machine (Do dialysis nurses have to run it, or can regular staff nurses be trained to run it?): who knows
Setting up the machine and hooking up the patient: 5-15 mins
How much fluid has to be removed for the patient to start to feel relief from SOB?
We're looking at AT LEAST 45 minutes, most likely more, for the patient to get relief.
Compare that to getting a vial of Lasix out of the med machine, drawing it up and injecting it - Taking into consideration time to start the IV? 10 mins, tops.
I admit I don't know any of the ins and outs of this treatment, but it seems a bit labor intensive to me.
Then again, in 20 years we'll probably all be sitting around the nurses station musing about how we used to treat CHF with Lasix! :)
At Thu Jul 05, 11:07:00 PM 2007,
Anonymous said…
About time!!I was in congestive heart failure 4 years ago. I noticed as time went on that I wasn't retaining the fluid other patients in my condition.This really made no sense.See,my kidneys produce no output.I am on dialysis.Then I figured out my not being short of breath with swollen ankles just like the other patients in congestive heart failur.Please understand I had other major symptom.I had openheart surgery and I'm soooo much better,But I always thought how sad that the other heart patients couldn't have their fluid dialyzed off as well. natalie
At Thu Jul 12, 05:22:00 PM 2007,
The Moose said…
I use this machine and I can tell you that it does not need central access (although that works well). It can use a 16 gauge return and either an extended length antecubital catheter or a trimmed Power PICC.
Dialysis nurses set up the machine and the CHF nurses manage it.
The fact of the matter is, that this machine DOES work and it removes far more SODIUM than diuretics do. I have done fifteen patients so far and the PATIENTS swear by it. My most recent patient left the hospital on NO diuretics and I saw him three weeks later and he was still edema free.
More info is needed but this therapy is for real.
At Mon Oct 22, 11:55:00 AM 2007,
Anonymous said…
This machine does what it says it does without the drugs and the damage these drugs can do to the kidneys. And yet we still have physicians whos say they need more data before they will use it on a patient. Dear Doctor, how much data is there on the safety of Lasix?
At Sun Feb 17, 09:52:00 PM 2008,
Anonymous said…
my mother was recently started on dialysis for removal of fluid due to CHF... her kidneys have not shut down. the doctors tell me they are doing ultrafiltration with a dialysis machine (which is very noisy). are there any places in the Chicago area that use this new machine? She is much improved (although very weak at this time). She can even sleep laying down rather than on a 30 degree incline!
At Wed Apr 09, 07:07:00 AM 2008,
Anonymous said…
I HAVE A PT WHO WAS GETTING IV LAXIX 80MG BID THIS PUT THE PT IN ACUTE RENAL FAILURE SOUNDS LIKE THIS AQUAPHERESIS WOULD HAVE BEEN A GREAT ALTERNATIVE TX FOR MY PT.
At Mon Sep 22, 05:53:00 PM 2008,
Anonymous said…
I work at an Iowa hospital that uses aquapheresis. To refer to geenas comment, it may take a little while to set it up, but I have not seen more than 90 minutes from when the physician ordered the therapy. Also, you referred to just give the Lasix, aquapheresis will take over where loop diuretics fail. After the body is given so many diuretics, it begins to work the opposite way and the body then absorbs more fluids. Aquapheresis first, will take off up to 4 liters of fluid per 24 hours, I have seen patients with 12 liters (one liter equals two pounds) removed who begin to walk again and do not have to use oxygen for the first time in years. Once the therapy is completed, then the diuretics begin to work again, diuresing the remaining amount of fluid.
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