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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThis article discusses the Cardiorenal Rescue Study in Acute Decompensated Heart Failure [CARRESS-HF; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00608491\u0026amp;atom=%2Fspmdc%2F12%2F18%2F24.atom\u0022\u003ENCT00608491\u003C\/a\u003E] trial that was simultaneously published in the \u003Cem\u003ENew England Journal of Medicine\u003C\/em\u003E [Bart BA et al. 2012].\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EHeart Failure\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ERenal Disease\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EBradley A. Bart, MD, Hennepin County Medical Center, Minneapolis, Minnesota, USA, presented the Cardiorenal Rescue Study in Acute Decompensated Heart Failure [CARRESS-HF; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00608491\u0026amp;atom=%2Fspmdc%2F12%2F18%2F24.atom\u0022\u003ENCT00608491\u003C\/a\u003E] trial that was simultaneously published in the \u003Cem\u003ENew England Journal of Medicine\u003C\/em\u003E [Bart BA et al. 2012].\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EAcute cardiorenal syndrome (Type 1), defined as worsening renal function in patients with acute decompensated heart failure (ADHF) [Ronco C et al. \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E 2012], occurs in 25% to 33% of patients with ADHF and is associated with poor outcomes [Ronco C et al. \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E 2012; Metra M et al. \u003Cem\u003ECirc Heart Fail\u003C\/em\u003E 2012].\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003ECARRESS-HF was a multicenter, prospective, randomized controlled trial designed to test whether ultrafiltration was superior to stepped pharmacologic therapy for the treatment of patients with ADHF.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EPatients hospitalized with ADHF and worsened renal function (defined as an increase in the serum creatinine level of at least 0.3 mg\/dL) 12 weeks before or 10 days after the index admission for heart failure (HF) were eligible for inclusion. Additional inclusion criteria included at least 2 of the following conditions at the time of randomization: at least 2+ peripheral edema, jugular venous pressure greater than 10 cm of water, or pulmonary edema or pleural effusion on chest radiography.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EIn total, 188 patients were randomized to a strategy of stepped pharmacologic therapy (n=94) or ultrafiltration (n=94). The primary endpoint was a composite of change from baseline in serum creatinine level and body weight at 96 hours. Clinical outcomes were assessed at 60 days.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EResults showed that ultrafiltration was inferior to pharmacologic therapy with respect to the primary endpoint of changes in serum creatinine and body weight at 96 hours (p=0.003); this was due primarily to an increase in creatinine levels in the ultrafiltration group.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EThe mean change in the creatinine level at 96 days was \u22120.04\u00b10.53 mg\/dL in the pharmacologic therapy group compared with +0.23\u00b10.70 mg\/dL in the ultrafiltration group (p=0.003). There was no significant difference in weight loss between patients in the pharmacologic therapy group and those in the ultrafiltration group 96 hours after enrollment (a loss of 5.5\u00b15.1 kg and 5.7\u00b13.9 kg, respectively; p=0.58). At 60 days, there was no difference in death (17% vs 14%; p=0.55) or HF hospitalization (26% vs 26%; p=0.97), but serious adverse events (AEs) were more frequent with ultrafiltration (p=0.03) and there was a significant increase in the rate of death or serious AE with ultrafiltration compared with pharmacologic therapy (HR, 1.50; 95% CI, 1.05 to 2.15; p=0.026; \u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/18\/24\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u002260-Day Outcomes Post-Randomization.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1702378428\u0022 data-figure-caption=\u002260-Day Outcomes Post-Randomization.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/18\/24\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/18\/24\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/18\/24\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/13098\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-9\u0022 class=\u0022first-child\u0022\u003E60-Day Outcomes Post-Randomization.\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EReproduced with permission from BA Bart, MD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-10\u0022\u003EDr. Bart concluded that, compared with pharmacologic therapy, ultrafiltration as administered in this study was associated with deterioration in renal function and worse clinical outcomes, and should not be used routinely in clinical practice. Whether or not ultrafiltration could be useful using slower rates of volume removal or as guided by hemodynamics is unknown. He said, \u201cTreatment of these patients with ADHF, worsened renal function, and persistent congestion remains a challenging clinical problem in need of better therapy.\u201d\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2012 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/12\/18\/24.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzn6n1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzn6n1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}