Ultrafiltration in Elderly Patients with Type 1 Cardiorenal Syndrome: Efficacy and Safety Outcomes.

Introduction: Due to the typical exclusion of very elderly patients from clinical trials, the applicability of trial results to this population with heart failure remains uncertain. Limited data exist regarding the efficacy and safety of ultrafiltration in elderly patients with type 1 cardiorenal syndrome (CRS). Consequently, our study aimed to compare the efficacy and safety of ultrafiltration versus diuretics, providing evidence-based insights into the optimal management strategy for elderly patients with type 1 CRS.

Methods: In this prospective pilot trial, patients aged over 70 years old with type I CRS were treated with either diuretics or ultrafiltration. All patients were followed for up to 180 days post-discharge. Efficacy outcomes encompassed both immediate measures (changes in weight and dyspnea score from baseline to 48 h posttreatment) and long-term stability indicators (length of hospital stay and heart failure-related medical visits within 180 days post-discharge). Safety outcomes were assessed in both groups, focusing on changes in systolic blood pressure, heart rate, serum creatinine, blood urea nitrogen, blood potassium, and sodium ion concentrations, bleeding or thromboembolic events, and major adverse cardiovascular events.

Results: A total of 159 patients with type I CRS were enrolled, with 80 receiving diuretics and 79 undergoing ultrafiltration. The mean age was 82.1 ± 5.8 years. At 48 h, patients in the ultrafiltration group demonstrated significantly greater weight loss and improvements in dyspnea score compared to those in the diuretic group (p < 0.05). Furthermore, the ultrafiltration group had shorter hospital stays and fewer medical visits for heart failure within 180 days post-discharge (p < 0.05). Notably, there were no statistically significant differences in safety outcomes between the two groups, indicating comparable safety profiles.

Conclusion: Ultrafiltration demonstrated superior efficacy with comparable safety profiles compared to diuretics. Therefore, ultrafiltration may be considered a preferred treatment option for elderly patients with type I CRS.