Sustained low-efficiency dialysis for refractory congestion in advanced cardiorenal syndrome: haemodyamics and weight reduction analysis
G Mihelcic, T Furlan, B LeskovarAbstract
Background
Patients with advanced cardiorenal syndrome who are ineligible for mechanical circulatory support or heart transplantation represent a high-risk and understudied population. Persistent congestion is common in this group and may become refractory to diuretic therapy. Sustained low-efficiency dialysis (SLED) may provide a haemodynamically tolerable strategy for gradual fluid removal in this setting.
Purpose
To evaluate changes in weight and haemodynamic changes during SLED treatment compared with standard medical therapy in patients with advanced heart failure and cardiorenal syndrome.
Methods
We conducted a single-centre, non-randomised retrospective cohort study of patients hospitalised with advanced heart failure, persistent congestion, and renal dysfunction between September 2002 and December 2024. The index date was defined as the time SLED was deemed clinically indicated. Patients who were treated with SLED formed the SLED group, while those who declined SLED and continued with medical therapy represented the standard therapy group. Recompensation in the SLED group was defined as the time when minimum steady-state body weight was achieved. In the standard therapy group, last follow-up was defined by the last documented clinical assessment. Body weight, systolic and diastolic blood pressure (SBP, DBP), and heart rate (HR) were recorded at index and follow-up. Differences between groups were assessed using independent (two-sample) t-tests, within-group changes were analysed using paired t-tests.
Results
At the index date, SBP, DBP, and HR were comparable between groups, while body weight was significantly higher in the SLED group (85±18 vs 75±16 kg, p=0.005). In the SLED group, recompensation was achieved after a median of 35 days (IQR 24–141), during which body weight decreased significantly (85±18 to 74±18 kg, p<0.001). Haemodynamic parameters remained largely stable, with a modest reduction in SBP (126±28 to 119±24 mmHg, p=0.049) and no significant changes in DBP or HR. In the standard therapy group, follow-up occurred after a median of 39 days (IQR 16–902); no significant change in body weight was observed, and haemodynamic parameters showed no statistically significant differences from baseline.
Conclusions
In persistently congested patients with advanced heart failure and renal dysfunction who were not candidates for advanced therapies, SLED was associated with substantial weight reduction during recompensation without evidence of clinically relevant haemodynamic instability. These findings suggest that SLED may facilitate clinical stabilisation in advanced cardiorenal syndrome and support the need for prospective evaluation.