19–21 Therefore, alternative and more effective methods of fluid removal are critically needed. 18 All other pharmacological approaches studied as adjuncts or alternative therapies for acute heart failure have failed to improve long-term outcomes.
Endnote uf trial#
17 Irrespective of diuretic strategy, 42% of acute heart failure subjects in the Diuretic Optimization Strategies Evaluation (DOSE) trial reached the composite endpoint of death, rehospitalisation, or A&E visit at 60 days. 16 Among more than 50,000 patients enrolled in the Acute Decompensated Heart Failure National Registry (ADHERE) and treated with conventional diuretic therapy, only 33% lost 2.3 kg or more, 16% gained weight during hospitalisation and almost 50% were discharged with unresolved congestion. The clinical hallmarks of diuretic resistance are insufficient symptom relief, higher risk of in-hospital worsening of heart failure, increased mortality after discharge and a threefold increase in rehospitalisation rates. 15,16 Several definitions of diuretic resistance and responsiveness have been proposed. 13,14ĭiuretics, the most widely used drugs to reduce fluid excess, become increasingly ineffective with heart failure progression as a result of impaired absorption, decreased renal blood flow, azotaemia and proteinuria, all resulting in reduced levels of active diuretics in the tubular lumen.
If a decrease in intravascular volume by fluid removal causes small transient increases in serum creatinine, achieving euvolaemia may still be essential to protect the kidneys in the long term. 8,10–12 The consistent finding that inadequate reduction of fluid excess in acute heart failure patients trumps increases in serum creatinine in predicting poor outcomes underscores the importance of effective decongestion. 4–9 Elevations of central venous pressure are rapidly transmitted to the renal veins, causing increased interstitial and tubular hydrostatic pressures, which decrease net glomerular filtration in both acute and chronic heart failure. 3Ībnormal fluid handling begins in the asymptomatic stages of heart failure and leads to physiological abnormalities in multiple organ systems. 1,2 Recurrent heart failure-related hospitalisations have uniformly been associated with worse outcomes, independent of age and renal function.
Therefore, the adsorbent of HA-UF is suggested to be a promising candidate for adsorption applications.Approximately 90% of the more than 1 million yearly heart failure hospitalisations in the US and Europe are a result of symptoms and signs of fluid overload and are associated with readmission rates of 24% and 50% at 30 days and 6 months, respectively.
The synthesized adsorbent is also reusable, with 88.59% of adsorption capacity remaining in the fifth recycle run. The Ho (pseudo-second-order) kinetics model represented the effect of contact time (kinetics) was represented by the Ho kinetics model. The effect of initial Pb(II) concentration (isotherm) shows that the data fitted well with the Langmuir-b isotherm model indicated the monolayer adsorption of Pb(II) onto homogenous surfaces of the HA-UF with the adsorption capacity of 2.26 × 10–4 mol/g (which is higher than its original HA of 1.12 × 10–4 mol/g). The higher ionic strength will affect decreasing adsorbed Pb(II) at the optimum pH of 5.5. Adsorption behavior of Pb(II) onto HA-UF was influenced by the ionic strength and pH, which were mainly driven by the ion exchange mechanism (EDR = 9.75 kJ/mol). The high stability of HA-UF was shown by 96.8% remaining in solid form at pH 12.4. The success of HA-UF formation was characterized by attenuated total reflection-infrared (ATR-IR), energy dispersive X-Ray (EDX), and X-ray diffraction (XRD). The reaction of the conducted the formation of HA-UF –COOH group of HA with the –NH2 group of UF was evidenced by decreasing total acidity from 549.26 cmol/kg (in HA) to 349.30 cmol/kg (in HA-UF). In this study, a new adsorbent of humic acid-urea formaldehyde (HA-UF) was synthesized. However, the literature has never written HA modification by UF to improve the adsorbent’s performance. Humic acid (HA) and urea-formaldehyde (UF) have been frequently reported as heavy metal adsorbents.
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