To evaluate the efficacy and safety of early application of ultra-filtration (UF) in patients hospitalized with acute heart failure (AHF) and volume overload.

Patients hospitalized with AHF and volume overload from January 2017 to January 2021 at the Department of Cardiology of People's Hospital of Qixingguan District were enrolled and divided into a medication group and an UF group using the random number table method. The former received standard medical therapy based on updated guidelines for heart failure (HF) combined with intensive diuretic therapy, and the latter received UF therapy within 24 hours after admission in combination with standard medical therapy. The efficacy parameters included loss of weight, decrease in plasma level of N terminal pro-B type natriuretic peptide (NT-proBNP), and decrease in central venous pressure (CVP) at 24 h after randomization in both groups. Moreover, length of stay (LOS) in hospital and rate of re-hospitalization for HF within 90 d of follow-up after discharge were also evaluated. The safety parameters included the change of blood pressure, heart rate, respiratory rate, and laboratory parameters after treatment.

A total of 198 patients were enrolled in this study, of whom 100 was allocated to the medication group and 98 patients to the UF group. The dose of intravenous furosemide for patients in the medication group was (108±27) mg (range, 80-200 mg). For patients in the UF group, the times of UF within 24 h were (2±1), the duration of UF was (19±2) h (range, 14-24 h), the volume of UF was (2896±921) ml (range, 660-5100 ml). Compared with those in the medication therapy group, there were significantly greater loss of weight [(-2.8±1.9) kg vs (-1.9±1.1) kg], decrease in plasma level of NT-proBNP [-8430 (-16 052, -5780) pg/ml vs -5780 (-12 070, -3630) pg/ml], and decrease in CVP [(-12±5) cmH₂O vs (-9±4) cmH₂O] in patients of the UF therapy group (P＜0.001). Furthermore, patients in the UF therapy group showed shorter LOS [(9±4) d vs (17±6) d, P＜0.001] and a lower rate of re-hospitalization for HF (21.4% vs 39.0%, P=0.007). Although the blood pressure, heart rate, and respiratory rate significantly decreased after UF therapy, only three patients (3.1%) showed systolic blood pressure＜90 mmHg. Moreover, there were no significant differences in renal function or serum electrolyte levels after UF therapy (P＞0.05). The changes of routine blood examination indexes were also within the safe range on clinical judgement.

Early application of UF therapy is effective and safe in patients hospitalized with AHF and volume overload.