Results of the RAPID-CHF Study

The RAPID-CHF study was a randomized controlled trial of 40 heart failure patients in six hospitals in Minneapolis/St. Paul. The patients were divided into two groups of 20: one group received a single eight-hour session of ultrafiltration, and the other group received the standard treatment for fluid overload in heart failure patients, which included 24 hours of diuretic treatment.

After 24 hours, significantly more excess fluid was removed from the patients who had received ultrafiltration.

Unlike diuretic treatment, ultrafiltration was not associated with significant changes in heart rate, blood pressure or electrolytes (small molecules, such as sodium, in our bodily fluids). At 38 hours, shortness of breath and other symptoms of fluid overload (such as swelling of the legs, feet or abdomen) were significantly improved in patients in the ultrafiltration group.

The researchers concluded that ultrafiltration is safe, well-tolerated and associated with effective fluid removal and relief of fluid-overload symptoms. They also concluded that there's no need to delay ultrafiltration therapy until diuretics fail. Patients who received ultrafiltration had an increased responsiveness to subsequent diuretic therapy and increased sodium excretion, despite decreasing doses of diuretics.

To learn more about fluid overload and ultrafiltration, take a gander at the links on the next page.

Diuretic Resistance and Heart Failure
When faced with diuretic resistance, doctors often try to modifying the dose of diuretics or manner of administration. For patients with moderate to severe heart failure, a continuous intravenous infusion of loop diuretics can result in improved elimination of excess fluid. It can also be helpful to use more than one type of diuretic drug. But unfortunately, in spite of these approaches, diuretic drugs still stop working for many patients.

The medical establishment has also raised concerns about the safety of diuretic drugs. A number of recent studies have shown that chronic use of these drugs results in an increased risk of death in this patient population.