NDT Advance Access published online on February 13, 2007
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfm004
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Intermittent haemodiafiltration in refractory congestive heart failure: BNP and balance of inflammatory cytokines
1Units of Nephrology, Dialysis, Transplantation,2Department of Respiratory Diseases, IRCCS Policlinico San Matteo and University of Pavia, 3Department of Cardiology and 4Department of health sciences, section of epidemiology and medical statistics, University of Pavia, Pavia, Italy
Correspondence and offprint requests to: Carmelo Libetta, MD (Italy), Associated Professor of Nephrology, Unità di Nefrologia Dialisi e Trapianto, IRCCS Policlinico San Matteo, P.le Golgi 2 27100 Pavia, Italy. Email: carmelo.libetta{at}unipv.it
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Abstract |
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Background. Elevated plasma levels of cytokines have been associated with an increased risk of congestive heart failure (CHF) even in people without history of myocardial infarction. Here we have tested the hypothesis that effective removal of pro-inflammatory cytokines in patients with advanced CHF unresponsive to diuretic treatment is associated with diuresis restoration and with a significant reduction of B-type natriuretic peptide (BNP) circulating levels.
Methods. We prospectively enrolled 10 patients with decompensated CHF (NYHA classes III–IV). Five patients unresponsive to diuretic treatment underwent a short course of intermittent haemodiafiltration (iHDF), whereas five patients responsive to diuretics were treated with intravenous boluses of furosemide. Renal function was similar between the two groups.
Results. Excess body fluids were removed in both groups always resulting in a reduction of pulmonary congestion and peripheral oedema. NYHA class improved in all patients, but one treated by intravenous boluses of furosemide. Only patients treated with iHDF showed a significant reduction of circulating interleukin-8 and monocyte chemoattractant protein-1. After the end of iHDF treatment, patients showed consistent restoration of diuretic responsiveness to significantly lower doses of oral furosemide up to one month of follow-up. Plasma levels of BNP before treatment were significantly higher in the iHDF group, lowering significantly in both groups after treatment.
Conclusions. Our results suggest that HDF is an effective treatment for patients with advanced CHF when cytokines have to be cleared and diuretic responsiveness needs to be restored. In our experience, iHDF is a cost-effective option when compared with continuous ultrafiltration methods because it can be performed in a routine dialysis unit without adjunctive costs for machinery or personnel training.
Keywords: BNP; congestive heart failure; cytokines; furosemide; haemodiafiltration
Received for publication: 14.12.06
Accepted in revised form: 3. 1.07
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