Ultrafiltration in the management of heart failure

PURPOSE OF REVIEW: Congestion causes the majority of hospitalizations for heart failure and contributes to heart failure progression and mortality. Intravenous loop diuretics reduce the signs and symptoms of congestion. Loop diuretics, however, may be associated with increased morbidity and mortality because of deleterious effects on neurohormonal activation, electrolyte balance, and cardiac and renal function. Ultrafiltration, an alternative method of sodium and water removal, safely improves hemodynamics in heart failure patients. RECENT FINDINGS: The Ultrafiltration versus Intravenous Diuretics for Patients Hospitalized for Acute Decompensated Heart Failure trial has recently shown that among 200 volume overloaded heart failure patients randomized to ultrafiltration or intravenous diuretics, 48 h weight (P = 0.001) and net fluid loss (P = 0.001) were greater in the ultrafiltration group. Dyspnea scores were similar. At 90 days, the ultrafiltration group had fewer heart failure rehospitalizations/patient (P = 0.022) and patients presenting for unscheduled visits (21 vs. 44%; P = 0.009). No serum creatinine differences occurred between the groups. SUMMARY: In decompensated heart failure, ultrafiltration safely produces greater weight and fluid loss than intravenous diuretics, reduces rehospitalization rates for heart failure and is an effective alternative therapy.