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Aquapheresis: A New Treatment for Heart Failure (Part 1)

Congestive heart failure (CHF) is a condition where the heart's pumping of blood is inadequate and consequently, fluid builds up in the lungs. (As a nod to my readers who are cardiologists -- CHF has many causes and is much more complicated that this simple explanation.) Symptoms of heart failure can include shortness of breath, low blood pressure, and a lack of blood flow to other organs of the body, like the kidneys.

Ninety percent of hospitalizations for congestive heart failure are due to shortness of breath from fluid overload. In patients with CHF, the major treatment for fluid overload has classically been diuretics injected intravenously. There are many types of diuretics, but Lasix (furosemide), is the one most commonly used.

The use of diuretics, while often quite effective, has many potential problems. First, an inadequate dose may be given, which may require a longer course of hospitalization until titration to the proper dose is achieved. Second, the patient may respond too well to the diuretic (a condition called "overdiuresis"), which can lead to low blood pressure and decreased kidney function. Third, even if the proper dose is given, diuretics may occasionally still lead to decreased kidney function and other complications, like low potassium.

For patients with congestive failure who already have significantly decreased kidney function, an alternative to diuretics is a process called "ultrafiltration." During dialysis -- a way of cleaning and filtering the blood using a dialysis machine -- fluid may be removed from the blood directly. In patients with CHF, ultrafiltration of extra fluid, which is performed during dialysis, can relieve symptoms of shortness of breath the same way diuretics can. The downside is that ultrafiltration requires a dialysis machine and is usually only used in patients with decreased kidney function.

In an attempt to overcome the problems with diuretics and the requirement of a dialysis machine for ultrafiltration, a company called CHF solutions has designed a device for ultrafiltration -- which they call "aquapheresis" -- called the AquaDex FlexFlow Fluid Removal System. A recently published study called the UNLOAD trial has shown impressive results in using the machine to treat patients with heart failure.

More in Part 2.
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Dr. Schwimmer's blog explores the intersection of medicine, new technologies, and the Internet.