{"id":"60240e3a5873","type":"article","url":"https://hartvaat.nl/2026/05/09/uf-care-trial-ultrafiltratie-bij-type-2-cardiorenaal-syndroom-geen-significante-/","title":"UF-CARE-trial: ultrafiltratie bij type-2 cardiorenaal syndroom geen significante winst (kleine, onderpowered RCT)","title_en":"","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["acuut-hartfalen","flow-trial","ijzertekort","step-hfpef","summit-trial"],"journal":"ESC heart failure","doi":"10.1093/eschf/xvag133","source_url":"https://doi.org/10.1093/eschf/xvag133","authors":["Maxime Schleef","Florence Sens","Laurent Magaud","Julie Haesebaert","Carole Langlois-Jacques","Laurent Juillard","Eric Bonnefoy","Guillaume Baudry"],"significance":6,"published":"2026-06-25","source_date":"2026-05-09","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/palliatief-hartfalen/","https://hartvaat.nl/kennis/hartfalen/icd-bij-hartfalen/"],"congress":"","summary_en":"UF-CARE was a multicenter, open-label randomised trial in 15 French centres in adults with severe heart failure, persistent or recurrent congestion despite high-dose diuretics and guideline-directed therapy, and mild-to-severe CKD (type 2 cardiorenal syndrome). 46 of 108 screened patients were randomised: 24 control (optimal medical therapy alone) and 22 ultrafiltration (peritoneal dialysis, haemodialysis, or isolated ultrafiltration based on clinical judgment, patient preference, and availability). The composite primary outcome (mortality or unplanned HF hospitalisation within 12 months) occurred in 63% of the ultrafiltration group and 87% of controls (p=0.144), after a median follow-up of 262 days. Quality of life improved slightly more with ultrafiltration; one technique-related death occurred. Conclusion: in this underpowered cohort, adding ultrafiltration did not significantly improve outcomes; larger trials are needed.","created":"2026-07-03T10:33:07Z","updated":"2026-07-03T18:39:36Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"UF-CARE was een multicenter, open-label gerandomiseerde studie in 15 Franse centra bij volwassenen met ernstig hartfalen, persisterende of recidiverende congestie ondanks hoge dosis diuretica en richtlijntherapie, en milde tot ernstige CKD (type 2 cardiorenaal syndroom). 46 van 108 gescreende patiënten werden gerandomiseerd: 24 controle (alleen optimale medische therapie) en 22 ultrafiltratie (peritoneale dialyse, hemodialyse of geïsoleerde ultrafiltratie naar klinisch oordeel + voorkeur + beschikbaarheid). De samengestelde primaire uitkomst (sterfte of ongeplande HF-opname binnen 12 maanden) trad op bij 63% in de ultrafiltratie-groep en 87% in de controlegroep (p=0,144), na mediaan 262 dagen follow-up. Kwaliteit van leven verbeterde licht meer in de ultrafiltratie-arm; één behandel-gerelateerde sterfte. Conclusie: in deze ondergerekruteerde groep gaf toegevoegde ultrafiltratie geen significant uitkomstvoordeel; grotere studies zijn nodig.","abstract_original":"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."}