Supplementary Material for: Reduction in Body Weight but Worsening Renal Function with Late Ultrafiltration for Treatment of Acute Decompensated Heart Failure

<b><i>Objectives:</i></b> The safety, effectiveness and indications for ultrafiltration (UF) are not well established. We hypothesized that UF would not worsen renal function in patients with heart failure (HF) who were not responding to medical therapy. <b><i>Methods:</i></b> Data was collected for patients who underwent UF between 2006 and 2010 (n = 72, median age 61 years, 54% males, 61% Caucasian, 54% left ventricular ejection fraction ≥40%). <b><i>Results:</i></b> Baseline GFR was 38 ml/min/ 1.73 m². All patients were initially treated with loop diuretics and 58% required a thiazide-like diuretic or vasoactive agent. UF resulted in total fluid removal of 11.3 liters and weight loss was 9.7 kg. The median decrease in eGFR during UF was 4.5 ml/min/m² (IQR –13, 0; p &lt;0.01) and 43% of patients experienced a ≥20% decrease in eGFR. Ten percent of patients required dialysis and 13% died, received a ventricular assist device/cardiac transplant or were discharged to hospice. <b><i>Conclusions:</i></b> In a cohort of HF patients who did not respond to medical therapy, UF was associated not only with a significant reduction of body weight and fluid removal, but also acute worsening of renal function. Further research to identify the appropriate population for UF, long-term outcomes and the intensity of treatment is required if UF is to gain wide acceptance for HF management.

**<i>研究目标：</i>** 超滤（ultrafiltration, UF）的安全性、有效性及适应证尚未明确。本研究假设：对于药物治疗应答不佳的心力衰竭（heart failure, HF）患者，超滤不会使其肾功能恶化。**<i>研究方法：</i>** 本研究收集了2006年至2010年间接受超滤治疗的72例患者的相关数据，患者中位年龄为61岁，男性占比54%，白种人占比61%，左心室射血分数≥40%的患者占比54%。**<i>研究结果：</i>** 患者基线肾小球滤过率（glomerular filtration rate, GFR）为38 ml/min/1.73 m²。所有患者初始治疗均采用袢利尿剂，其中58%的患者需加用噻嗪样利尿剂或血管活性药物。超滤治疗的总脱水量为11.3升，患者体重平均下降9.7 kg。治疗期间估算肾小球滤过率（estimated glomerular filtration rate, eGFR）的中位下降值为4.5 ml/min/m²（四分位距[IQR]：–13, 0；p <0.01），43%的患者eGFR下降幅度≥20%。10%的患者需接受透析治疗，13%的患者死亡、接受心室辅助装置（ventricular assist device, VAD）植入/心脏移植，或转至临终关怀机构。**<i>研究结论：</i>** 在药物治疗应答不佳的心力衰竭患者队列中，超滤治疗不仅可显著减轻体重、清除体内多余液体，还会导致肾功能急性恶化。若要使超滤治疗被广泛应用于心力衰竭管理，仍需开展进一步研究以明确其适宜人群、远期预后及治疗强度。