Efficacy and safety of ultrafiltration in the treatment for elderly patients with heart failure and frailty

doi:10.11958/20231308

Abstract

Abstract:

Objective To investigate the efficacy and safety of ultrafiltration therapy in elderly patients with congestive heart failure (CHF) and frailty. Methods A total of 88 hospitalized elderly patients with CHF and frailty were randomly assigned to the ultrafiltration group (n=44) and the control group (n=44). The control group treated with standard drug therapy. The ultrafiltration group treated with ultrafiltration, however, diuretics were not used during ultrafiltration treatment. Efficacy assessment was compared between the two groups, including patient body weight, N-terminal pro-brain natriuretic peptide (NT-proBNP) levels at 48 hours after treatment, dyspnea severity scores at 48 hours and 1 week after treatment, hospitalization duration and readmission rate within 3 months. Safety assessment parameters included serum creatinine, urea nitrogen, Na⁺ and K⁺concentration at 48 hours after treatment and creatinine level 1 week after treatment. Results Efficacy assessment indicated that at 48 hours after treatment, both groups showed a significant reduction in patient body weight and NT-proBNP levels compared to pre-treatment levels (P<0.05). However, there were no significant difference in body weight and NT-proBNP levels before and after treatment between the two groups (P>0.05). Dyspnea severity scores for both groups increased at 48 hours after treatment, then decreased at 1 week after treatment. The ultrafiltration group exhibited higher dyspnea severity scores than that of the control group at 48 hours after treatment (P<0.05). The length of hospital stay and the rate of re-hospitalization within 3 months were lower in the ultrafiltration group compared to those of the control group (P<0.05). Safety assessment revealed that there were no significant differences in serum urea nitrogen and Na⁺ levels before and 48 hours after treatment between the two groups (P>0.05). However, serum K⁺ levels were higher after 48-hours treatment in the ultrafiltration group than those of the control group (P<0.05). There were no significant changes in creatinine levels before and after treatment in the control group (P>0.05), while creatinine levels were lower 1 week after treatment in the ultrafiltration group compared to those of pre-treatment and 48 hours after treatment, and were lower than those of the control group (P<0.05). Conclusion Ultrafiltration is a safe and effective method for elderly patients with CHF and frailty.

Key words: heart failure, frailty, aged, ultrafiltration

CLC Number:

R541.4

Figures/Tables 6

References 17

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组别	男性		年龄/岁		基础病			心衰病因
组别	男性		年龄/岁		2型糖尿病		高血压	缺血性心肌病		瓣膜病	高血压性心脏病	扩张型心肌病		其他
常规组	25（56.82）		75.00（67.00，77.75）		13（29.55）		19（43.18）	20（45.45）		3（6.82）	15（34.09）	4（9.09）		2（4.55）
超滤组	23（52.27）		72.00（68.00，78.00）		15（34.09）		23（52.27）	22（50.00）		1（2.27）	17（38.64）	3（6.82）		1（2.27）
χ²或Z	0.183		0.029		0.210		0.729	1.778
组别		心衰用药									Fried衰弱表型/分		LVEF
组别		螺内酯		ACEI/ARB		β受体阻滞剂			SGLT-2抑制剂		Fried衰弱表型/分		LVEF
常规组		39（88.64）		40（90.91）		38（86.36）			12（27.27）		4.00（3.00，4.75）		0.42±0.08
超滤组		35（79.55）		41（93.18）		35（79.55）			9（20.45）		4.00（3.00，4.00）		0.41±0.08
χ²		1.359		0.155		0.723			0.563		0.040		0.834

组别	男性		年龄/岁		基础病			心衰病因
组别	男性		年龄/岁		2型糖尿病		高血压	缺血性心肌病		瓣膜病	高血压性心脏病	扩张型心肌病		其他
常规组	25（56.82）		75.00（67.00，77.75）		13（29.55）		19（43.18）	20（45.45）		3（6.82）	15（34.09）	4（9.09）		2（4.55）
超滤组	23（52.27）		72.00（68.00，78.00）		15（34.09）		23（52.27）	22（50.00）		1（2.27）	17（38.64）	3（6.82）		1（2.27）
χ²或Z	0.183		0.029		0.210		0.729	1.778
组别		心衰用药									Fried衰弱表型/分		LVEF
组别		螺内酯		ACEI/ARB		β受体阻滞剂			SGLT-2抑制剂		Fried衰弱表型/分		LVEF
常规组		39（88.64）		40（90.91）		38（86.36）			12（27.27）		4.00（3.00，4.75）		0.42±0.08
超滤组		35（79.55）		41（93.18）		35（79.55）			9（20.45）		4.00（3.00，4.00）		0.41±0.08
χ²		1.359		0.155		0.723			0.563		0.040		0.834

组别	体质量/kg			NT-proBNP/（ng/L）
组别	治疗前	治疗48 h后	t_配对	治疗前	治疗48 h后	Z_配对
常规组	65.10±10.18	63.36±9.57	10.114^＊	4 550（2 962，10 441）	3 500（2 075，8 526）	5.345^＊
超滤组	63.76±9.54	61.51±8.59	11.554^＊	4 534（3 456，6 092）	2 633（1 875，4 569）	5.777^＊
t	0.634	0.955		0.188	1.315

组别	体质量/kg			NT-proBNP/（ng/L）
组别	治疗前	治疗48 h后	t_配对	治疗前	治疗48 h后	Z_配对
常规组	65.10±10.18	63.36±9.57	10.114^＊	4 550（2 962，10 441）	3 500（2 075，8 526）	5.345^＊
超滤组	63.76±9.54	61.51±8.59	11.554^＊	4 534（3 456，6 092）	2 633（1 875，4 569）	5.777^＊
t	0.634	0.955		0.188	1.315

组别	治疗前	治疗48 h后	治疗1周后
常规组	3.0（2.0，4.0）	11.00（7.25，12.75）	10.00（10.00，14.00）
超滤组	3.0（2.0，4.0）	12.00（11.00，15.00）	11.50（10.00，14.00）
Z	0.248	3.084^＊	1.041