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How do diuretic drugs and ultrafiltration compare?

The Relief for Acutely Fluid Overloaded Patients with Decompensated Congestive Heart Failure (RAPID-CHF) study compared the safety and effectiveness of ultrafiltration and diuretic drugs. The study determined that ultrafiltration is more effective in removing excess fluids.

In addition to the RAPID-CHF trial, the UNLOAD trial compared ultrafiltration with standard intravenous diuretic therapy for heart failure patients. Patients diagnosed with volume overload were randomized to ultrafiltration or intravenous diuretics. The goals of the trial were to assess for weight loss and shortness of breath at 48 hours after the initial randomization. This trial also looked at net fluid loss at 2 days, functional capacity of patients, heart failure rehospitalizations, and unscheduled visits within a three-month period. This trial also included safety parameters including kidney function, electrolyte levels, and blood pressure. At this 48-hour time point, patient weight and net fluid loss showed greater improvement in the ultrafiltration arm of the trial. Patients' subjective shortness of breath was similar between both groups. Interestingly, at the 90-day period, the ultrafiltration group had fewer patients rehospitalized for heart failure. From a safety standpoint, no significant differences in kidney function were noticed between both groups. A conclusion of the trial noted that in patients with decompensated heart failure, ultrafiltration produced greater weight loss and fluid loss than intravenous diuretics. The ultrafiltration arm of the trial also had the added benefit of less readmission to the hospital for decompensated heart failure.

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