Renal replacement therapy in type 2 severe cardiorenal syndrome: a randomized controlled trial
BACKGROUND: Type 2 cardiorenal syndrome (CRS), characterized by chronic heart failure (HF) leading to chronic kidney disease (CKD), is associated with high morbidity and mortality. In patients with refractory congestive HF, extrarenal fluid removal techniques can be proposed. We aimed to evaluate whether adding ultrafiltration through peritoneal dialysis (PD), haemodialysis (HD) or isolated ultrafiltration (IUF) improves clinical outcomes compared with optimized medical therapy alone. METHODS: UF-CARE was a multicentre, randomized, controlled, open-label trial conducted in 15 French centres. Adults with severe HF, persistent or recurrent congestion despite high-dose diuretics and guideline-directed medical therapy, and mild to severe CKD were randomized to optimized medical therapy alone (Control group) or optimized medical therapy plus ultrafiltration (Ultrafiltration group), through PD, HD or IUF, according to clinical judgment, patient characteristics and preferences, and availability in each centre. The primary outcome was a composite of all-cause mortality or unplanned hospitalization for acute HF within 12 months. RESULTS: Among 108 screened patients, 46 were randomized (24 Control group, 22 Ultrafiltration group). After a median follow-up of 262 days, the primary outcome occurred in 63% of patients in the Ultrafiltration group and 87% in the Control group (p = 0.144). Quality-of-life scores seemed to improve over time in both groups, with a slightly more sustained improvement in the ultrafiltration group. One death related to the technique was reported. CONCLUSION: In patients with type 2 CRS and refractory congestive HF, adding ultrafiltration through PD, HD or IUF did not significantly reduce mortality or HF-related hospitalizations at 12 months compared with optimized medical therapy and close multidisciplinary follow-up, although the trial was underpowered. CLINICAL TRIAL REGISTRATION: NCT02846337.
Authors
- Aurélien Piraud (ORCID: https://orcid.org/0009-0006-1368-4140)
- Florence Sens (ORCID: https://orcid.org/0000-0001-8007-9713)
- Maxime Schleef (ORCID: https://orcid.org/0000-0002-3711-7259)
- Jean‐Baptiste Gourraud
- Charles Chazot (ORCID: https://orcid.org/0000-0002-6509-420X)
- Laurent Sebbag
- Marie Viprey (ORCID: https://orcid.org/0000-0002-3281-1970)
- C. Lessoré (ORCID: https://orcid.org/0009-0008-9767-5704)
- Carole Langlois‐Jacques
- Marie‐Béatrice Nogier (ORCID: https://orcid.org/0000-0001-9888-2547)
- Mohamed Ouethrani
- Pierre‐Yves Courand (ORCID: https://orcid.org/0000-0003-3199-7977)
- Marie‐France Seronde (ORCID: https://orcid.org/0000-0003-0435-5127)
- Laurianne Le Gloan (ORCID: https://orcid.org/0000-0002-9194-4845)
- Clémence Bechade (ORCID: https://orcid.org/0000-0002-8481-6589)
- Denis Angoulvant (ORCID: https://orcid.org/0000-0003-0788-8092)
- Julie Haesebaert (ORCID: https://orcid.org/0000-0001-9109-5604)
- Laurent Magaud (ORCID: https://orcid.org/0000-0002-2973-410X)
- Laurence Godard
- Audrey Beq
- M. Nouvier (ORCID: https://orcid.org/0000-0002-1926-7843)
- Lydie Poinsignon
- Laurent Juillard
- Katrien Blanchart (ORCID: https://orcid.org/0000-0002-5849-0917)
- Carine Mouly-Bertin
- C. Tulane
- Isabelle Deleruyelle
- P Fromage
- Emmanuel Villar
- Guillaume Baudry (ORCID: https://orcid.org/0000-0002-9200-2729)
- Laetitia Touihri Maximin
- Gaëlle Landry
- Romain Didier
- Stephane Roueff
- Eric Bonnefoy
- Evelyne Micor
- Patrick Rossignol
- Celine Thiebaut
- for the UF-CARE Study Group
- Anne Jolivot
- Nicolas Girerd
- Nicolas Bihry
- Didier Aguilera
- Marie Essig
- Carole Zini
- Jean Bories
- Samuel Martin Frouillou
- Aude Roucher
- Sophie Rippert
- Christophe Mariat
- Luc Frimat
- Marie Fertin
- Francois Roubille
- Muriel Rabilloud
- Olivier Lairez
- Helena Hadjisavvas
- Stephane Manzo-Silberman
- Nathan Mewton
- Ahmed Arkitis
- Xavier Marccagi
- Cecile Couriveaud
- William Hanf
- Yannick Le Meur
Institutions
- Université Claude Bernard Lyon 1 (FR)
- Inserm (FR)
- Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement (FR)
- Association pour l'Utilisation du Rein Artificiel dans la région Lyonnaise (FR)
- Hospices Civils de Lyon (FR)
- Centre d’Investigation Clinique Innovation Technologique de Nancy (FR)
- Laboratoire de recherche en cardiovasculaire, métabolisme, diabétologie et nutrition (FR)
- French Clinical Research Infrastructure Network (FR)
- Université de Lorraine (FR)
Publication Details
- Journal
- ESC Heart Failure
- Published
- 2026-05-08
- DOI
- https://doi.org/10.1093/eschf/xvag133
- Primary Topic
- Dialysis and Renal Disease Management
- Type
- article
- Field-Weighted Citation Impact
- 0.00