Slow continuous ultrafiltration and prolonged intermittent renal replacement therapy: Tailoring renal replacement therapy in intensive care unit

Table 5 Principal clinical studies of slow continuous ultrafiltration, prolonged intermittent renal replacement therapy, and sustained low-efficiency dialysis

Ref.	Population/setting	Modality and comparator	Design (n)	Principal outcomes	Key findings
Wei et al[33], 1995	Severe cardiac failure with diuretic resistance	SCUF	Prospective (n = 7)	Hemodynamic tolerance	UF approximately 2.2 L/session; stable BP
Bart et al[34], 2005 (RAPID-CHF)	ADHF with congestion	UF vs diuretics	RCT (n = 40)	Fluid removal	UF > diuretics (4650 vs 2838 mL)
Costanzo et al[35], 2007 (UNLOAD)	ADHF with overload	UF vs diuretics	RCT (n = 200)	Weight; rehospitalization	Improved decongestion; HF readmissions decrease
Paladino et al[36], 2008	ADHF + hypercapnia	SCUF	Prospective (n = 10)	Hemodynamics; gas exchange	Improved CO2 clearance
Giglioli et al[38], 2010	NYHA III-IV HF	UF	Prospective (n = 15)	New York Heart Association; BNP	Weight decreasing 7.4%; BNP improved
Guiotto et al[26], 2010	Severe ADHF	Ultrasound-guided SCUF	Prospective (n = 24)	Volume removal	Approximately 5.8 L/session; stable BP
Giglioli et al[37], 2011 (ULTRADISCO)	Severe ADHF	Hemodynamic-guided UF	Prospective (n = 30)	Neurohormonal markers	Aldosterone decreas, NT-proBNP, CO increase
Bart et al[39], 2012 (CARRESS-HF)	ADHF + renal dysfunction	UF vs stepped therapy	RCT (n = 188)	Renal function; safety	UF worsened Cr; increase adverse events
Patarroyo et al[21], 2012	Refractory ADHF	UF	Retrospective (n = 63)	Mortality	High mortality; dialysis predicted poor outcome
Marenzi et al[42], 2014 (CUORE)	Severe HF	UF + diuretics vs diuretics	RCT (n = 56)	Rehospitalization	HF readmissions decrease; stable renal function
Costanzo et al[43], 2016 (AVOID-HF)	ADHF	Adjustable UF vs diuretics	RCT (n = 224)	HF events	Trend to benefit; adverse events increase
Marshall et al[58], 2011	ICU AKI	PIRRT vs CRRT	Time-series (n = 1347)	Hospital mortality	No mortality increasing with PIRRT
Dash et al[59], 2025	ICU AKI	SLED vs CRRT	Prospective (n = 67)	28-day mortality	Similar mortality; fewer clots in SLED
Kitchluet al[60], 2015	ICU AKI	SLED vs CRRT	Retrospective (n = 232)	30-day mortality	Adjusted outcomes similar
Harveyet al[61], 2021	Critical illness AKI	SLED vs CRRT	Retrospective (n = 284)	1-year mortality	Mortality equivalent across groups
Sharieff et al[62], 2024	ICU AKI + instability	SLED	Retrospective (n = 58)	Mortality	Severity, not modality, drove outcomes
Maiwallet al[63], 2025 (ELDICS)	Cirrhosis + septic shock + AKI	Early vs late SLED	RCT (n = 50)	Mortality; hypotension	Early SLED decrease hypotension, renal recovery increase
Hu et al[44], 2020	Early ADHF	UF vs diuretics + tolvaptan	RCT (n = 100)	Weight; diuresis	Greater decongestion with UF
Di Marioet al[65], 2025	ICU AKI	SLED + RCA	Prospective (n = 27)	Safety; feasibility	88% session completion; no citrate toxicity

This table summarizes key clinical investigations of slow continuous ultrafiltration, prolonged intermittent renal replacement therapy, and sustained low-efficiency dialysis in acute heart failure and acute kidney injury. SCUF: Slow continuous ultrafiltration; ADHF: Acute decompensated heart failure; UF: Ultrafiltration; RCT: Randomized controlled trial; HF: Heart failure; BNP: B-type natriuretic peptide; BP: Blood pressure; CO: Cardiac output; ICU: Intensive care units; AKI: Acute kidney injury; PIRRT: Prolonged intermittent renal replacement therapy; SLED: Sustained low-efficiency dialysis; CRRT: Continuous renal replacement therapy; NT-proBNP: N-terminal pro-B-type natriuretic peptide; RCA: Regional citrate anticoagulation.