Reconsidering Ultrafiltration in the Acute Cardiorenal Syndrome

Aggressive diuretic therapy in a patient who is hospitalized for acute decompensated heart failure often leads to progressive renal dysfunction despite persistent congestion. The underlying mechanisms of this so-called acute cardiorenal syndrome are complex and not fully understood.1,2 As initial therapy in this setting, ultrafiltration as compared with diuretic therapy may result in a higher rate of sodium and volume removal, with greater weight loss and less frequent rehospitalizations.3,4 These findings have suggested that ultrafiltration can provide more effective relief of congestion than pharmacologic therapy can, particularly in the setting of cardiorenal compromise. Ultrafiltration may also reduce diuretic-induced . . .