Extracorporeal Ultrafiltration for Acute Heart Failure

Acute decompensated heart failure (ADHF) has the highest rate of hospital readmission among all medical conditions and portends a significant financial burden on healthcare systems worldwide. Hospitalization for ADHF is primarily driven by congestion, with intravenous loop diuretics representing the cornerstone of therapy. However, it is well described that a significant subset of patients is discharged with residual fluid overload. While the cause of the incomplete decongestion is multifactorial, the development of diuretic resistance is a well-characterized contributing factor with consequent poor outcomes. Moreover, the therapeutic response to diuretics is known to lack predictability. Extracorporeal ultrafiltration (a mechanical pump-driven therapy) has emerged as an option to overcome shortcomings of the diuretics. It allows clinicians to customize the volume and the rate of fluid removal to the needs and clinical characteristics of the patients. The results of the currently available studies indicate that this therapy is associated with more efficient fluid and sodium removal compared to medical therapy, hence leading to reduction in the rate of readmissions and a potential salutary impact on the financial burden associated with the care of these patients. While isolated ultrafiltration can be performed by conventional machines used for renal replacement therapy, the advent of simplified, portable, and user-friendly devices that are specifically designed for extracorporeal ultrafiltration therapy has further enhanced the interest in this therapeutic modality and increased the potential for its more widespread use. Further, development in this direction through device miniaturization may extend the horizons of indications and the applicability of this therapy even in the ambulatory settings.