Effectiveness of Ultrafiltration in Treating People With Acute Decompensated Heart Failure and Cardiorenal Syndrome (The CARRESS Study)

Last updated: May 15, 2013
Sponsor: Duke University
Overall Status: Completed

Phase

3

Condition

Hyponatremia

Heart Failure

Chest Pain

Treatment

N/A

Clinical Study ID

NCT00608491
Pro00018064
U01HL084904-04
522
U01HL084904
  • Ages > 18
  • All Genders

Study Summary

Heart failure is a serious condition in which the heart's ability to pump blood through the body is impaired, often making a person feel weak or fatigued. When a person's condition worsens to the point of hospitalization, that person is said to have acute decompensated heart failure (ADHF). Abnormal kidney function in association with cardiac distress, known as cardiorenal syndrome, is a common complication of heart failure and causes further medical problems and need for hospitalization. While there are various effective treatments for heart failure, more research is needed to determine the best treatment for targeting both ADHF and cardiorenal syndrome. This study will compare the safety and effectiveness of ultrafiltration versus standard medical drug therapy in improving renal function and relieving fluid buildup in people hospitalized with ADHF and cardiorenal syndrome.

Eligibility Criteria

Inclusion

Inclusion criteria:

  • age 18 or older

  • admitted to the hospital with a primary diagnosis of decompensated heart failure

  • onset of cardiorenal syndrome after hospitalization or pre-hospitalization

  • after hospitalization - onset of cardiorenal syndrome after hospitalization must occurwithin 10 days from the time of admission after receiving IV diuretics

  • pre-hospitalization - onset of cardiorenal syndrome pre-hospitalization must occurwithin 12 weeks of the index hospitalization in the setting of escalating doses ofoutpatient diuretics

  • persistent volume overload

Exclusion

Exclusion criteria:

  • intravascular volume depletion based on investigator‟s clinical assessment

  • acute coronary syndrome within 4 weeks

  • indication for hemodialysis

  • creatinine > 3.5 mg per deciliter at admission to the hospital

  • systolic blood pressure < 90 mmHg at the time of enrollment

  • alternative explanation for worsening renal function such as obstructivenephropathy,contrast induced nephropathy, acute tubular necrosis

  • Hematocrit > 45%

  • poor venous access

  • clinical instability likely to require the addition of intravenous vasoactive drugsincluding vasodilators and/or inotropic agents

  • allergy or contraindications to the use of heparin

  • the use of iodinated radio contrast material in the last 72 hours or anticipated useof IV contrast during the current hospitalization

  • known bilateral renal artery stenosis

  • active myocarditis

  • hypertrophic obstructive cardiomyopathy

  • severe valvular stenosis

  • complex congenital heart disease

  • sepsis or ongoing systemic infection

  • enrollment in another clinical trial involving medical or device based interventions

Study Design

Total Participants: 188
Study Start date:
March 01, 2008
Estimated Completion Date:
June 30, 2012

Study Description

Heart failure is a common condition that affects approximately 5 million people in the United States, with 550,000 new cases diagnosed each year. Common symptoms of heart failure include swelling and fluid buildup in the legs, feet, and/or lungs; shortness of breath; coughing; elevated heart rate; change in appetite; and fatigue. If left untreated, the condition of the heart may deteriorate so far that the person undergoes ADHF. The number of hospitalizations attributed to ADHF has risen significantly, with many people readmitted soon after discharge because of recurring symptoms or further medical complications, such as cardiorenal syndrome. Current heart failure treatments focus on removing excess fluid buildup, often by increasing urination with diuretic medications or by draining directly from the veins. Direct drainage from the veins, also known as ultrafiltration, may be the more effective method for treating people with ADHF and cardiorenal syndrome. This study will compare the safety and effectiveness of ultrafiltration versus standard medical drug therapy in improving renal function and relieving fluid buildup in people hospitalized with ADHF and cardiorenal syndrome.

Participation in this study will last 60 days. All potential participants will undergo initial screening, which will include a medical history, physical exam, blood draws, measurements of fluid intake and urine output, and questionnaires. These same evaluations and procedures will be repeated at various points during the hospital stay. Eligible participants will be randomly assigned to receive standard medical drug therapy or fluid removal by ultrafiltration. Standard medical drug therapy will involve the intravenous delivery of diuretics and possibly other doctor-recommended medications. Ultrafiltration will involve intravenously removing blood, passing it through an ultrafiltration device, and then returning the blood to the participant. During ultrafiltration, participants will be treated with a blood thinner through the IV, as well.

Follow-up assessments will occur at Days 30 and 60 after treatment. Follow-up assessments will include measurements of fluid intake, urine output, and vital signs; blood draws; physical exams; and questions about medications and status of recovery.

Connect with a study center

  • Montreal Heart Institute

    Montreal, Quebec H1T - 1C8
    Canada

    Site Not Available

  • Mayo Clinic Arizona

    Phoenix, Arizona 85054
    United States

    Site Not Available

  • Morehouse School of Medicine

    Atlanta, Georgia 30310
    United States

    Site Not Available

  • Minnesota Heart Failure Network

    Minneapolis, Minnesota 55415
    United States

    Site Not Available

  • Mayo Clinic

    Rochester, Minnesota 55905
    United States

    Site Not Available

  • Duke University Medical Center

    Durham, North Carolina 27705
    United States

    Site Not Available

  • Baylor College of Medicine

    Houston, Texas 77030
    United States

    Site Not Available

  • University of Utah Health Sciences Center

    Murray, Utah 84107
    United States

    Site Not Available

  • University of Vermont - Fletcher Allen Health Care

    Burlington, Vermont 05401
    United States

    Site Not Available

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