A wearable hemofilter for continuous ambulatory ultrafiltration.

Ultrafiltration is effective for treating fluid overload, but there are no suitable machines for ambulatory treatment. This study summarizes the use of a light-weight wearable continuous ambulatory ultrafiltration device consisting of a hollow fiber hemofilter, a battery operated pulsatile pump, and two micropumps to control heparin administration and ultrafiltration. Six volume-overloaded patients underwent ultrafiltration for 6 h with treatment discontinued in one patient due to a clotted catheter. Blood flow averaged 116 ml min(-1), the ultrafiltration rate ranged from 120-288 ml h(-1) with about 150 mmol of sodium removed. Blood pressure, pulse, and biochemical parameters remained stable with no significant hemolysis or complications. Our data show that the wearable hemofilter appears to be safe, effective, and practical for patients. This device could have a major impact on the quality of life of fluid-overloaded patients with heart failure. Additional studies will be needed to confirm these initial promising results.

[1]  F. Fouad-Tarazi,et al.  Isolation of "myocardial depressant factor(s)" from the ultrafiltrate of heart failure patients with acute renal failure. , 1996, ASAIO journal.

[2]  E. Rambod,et al.  Continuous Renal Replacement Therapy for Congestive Heart Failure: The Wearable Continuous Ultrafiltration System , 2006, ASAIO journal.

[3]  L. Stevenson,et al.  Aggravated renal dysfunction during intensive therapy for advanced chronic heart failure. , 1999, American heart journal.

[4]  L. Stevenson Tailored therapy to hemodynamic goals for advanced heart failure , 1999, European journal of heart failure.

[5]  W Kolff,et al.  Portable/wearable artificial kidney (WAK) - initial evaluation. , 1976, Proceedings of the European Dialysis and Transplant Association. European Dialysis and Transplant Association.

[6]  M. Guazzi,et al.  Sustained improvement in functional capacity after removal of body fluid with isolated ultrafiltration in chronic cardiac insufficiency: failure of furosemide to provide the same result. , 1994, The American journal of medicine.

[7]  R. Bellomo,et al.  Extracorporeal Ultrafiltration for the Treatment of Overhydration and Congestive Heart Failure , 2002, Cardiology.

[8]  C. Ronco,et al.  Extracorporeal Ultrafiltration for Acute Exacerbations of Chronic Heart Failure: Report from the Acute Dialysis Quality Initiative , 2005, The International journal of artificial organs.

[9]  D. Brutsaert,et al.  New concepts in diastolic dysfunction and diastolic heart failure: Part I: diagnosis, prognosis, and measurements of diastolic function. , 2002, Circulation.

[10]  M. Guglin,et al.  Ultrafiltration versus intravenous diuretics for patients hospitalized for acute decompensated heart failure. , 2007, Journal of the American College of Cardiology.

[11]  E. Paganini,et al.  Refractory congestive heart failure: overview and application of extracorporeal ultrafiltration. , 1996, Advances in renal replacement therapy.

[12]  J. Cohn,et al.  Acute vasoconstrictor response to intravenous furosemide in patients with chronic congestive heart failure. Activation of the neurohumoral axis. , 1985, Annals of internal medicine.

[13]  D R Jacobs,et al.  Weight gain continues in the 1990s: 10-year trends in weight and overweight from the CARDIA study. Coronary Artery Risk Development in Young Adults. , 2000, American journal of epidemiology.

[14]  Allen R Nissenson,et al.  Continuously functioning artificial nephron system: The promise of nanotechnology , 2005, Hemodialysis international. International Symposium on Home Hemodialysis.

[15]  L. Henderson,et al.  Treatment of severe fluid overload by ultrafiltration. , 1974, The New England journal of medicine.

[16]  W. Abraham,et al.  Hormones and hemodynamics in heart failure. , 1999, The New England journal of medicine.

[17]  Y Wang,et al.  Readmission after hospitalization for congestive heart failure among Medicare beneficiaries. , 1997, Archives of internal medicine.

[18]  J. Gardin,et al.  Outcome of Congestive Heart Failure in Elderly Persons: Influence of Left Ventricular Systolic Function: The Cardiovascular Health Study , 2002, Annals of Internal Medicine.

[19]  C. Fischer,et al.  Hemodynamic changes during hemodialysis, sequential ultrafiltration, and hemofiltration. , 1980, Kidney international. Supplement.

[20]  Hans-Dietrich Polaschegg,et al.  Continuous Renal Replacement Therapy for End-Stage Renal Disease , 2005 .

[21]  M. Guazzi,et al.  Apparent paradox of neurohumoral axis inhibition after body fluid volume depletion in patients with chronic congestive heart failure and water retention. , 1994, British heart journal.

[22]  A. Charlesworth,et al.  Renal function, neurohormonal activation, and survival in patients with chronic heart failure. , 2000, Circulation.

[23]  L. Stevenson,et al.  Medical management of advanced heart failure. , 2002, JAMA.

[24]  J. Gribben,et al.  Ultrafiltration in the management of refractory congestive heart failure. , 1986, British heart journal.

[25]  M. Emdin,et al.  Treatment of end-stage congestive heart failure by extracorporeal ultrafiltration. , 1987, The American journal of cardiology.

[26]  D. Matthaei,et al.  Arteriovenous haemofiltration: A new and simple method for treatment of over-hydrated patients resistant to diuretics , 1977, Klinische Wochenschrift.

[27]  G. MacGowan,et al.  Intermittent outpatient ultrafiltration for the treatment of severe refractory congestive heart failure. , 2004, Journal of cardiac failure.

[28]  G. Fonarow Pharmacologic therapies for acutely decompensated heart failure. , 2002, Reviews in cardiovascular medicine.

[29]  J. Bristow,et al.  Clinical and hemodynamic results of peritoneal dialysis for severe cardiac failure. , 1968, American heart journal.

[30]  C. O'connor,et al.  Diuretic resistance predicts mortality in patients with advanced heart failure. , 2002, American heart journal.

[31]  H. Fillit,et al.  Elevated circulating levels of tumor necrosis factor in severe chronic heart failure. , 1990, The New England journal of medicine.