Extracorporeal Ultrafiltration for Fluid Overload in Heart Failure

More than 1 million heart failure hospitalizations occur annually, and congestion is the
predominant cause. Rehospitalizations for recurrent congestion portend poor outcomes
independently of age and renal function. Persistent congestion trumps serum creatinine increases
in predicting adverse heart failure outcomes. No decongestive pharmacological therapy has
reduced these harmful consequences. Simplified ultrafiltration devices permit fluid removal in
lower-acuity hospital settings, but with conflicting results regarding safety and efficacy.
Ultrafiltration performed at fixed rates after onset of therapy-induced increased serum creatinine
was not superior to standard care and resulted in more complications. In contrast, compared with
diuretic agents, some data suggest that adjustment of ultrafiltration rates to patients’ vital signs and
renal function may be associated with more effective decongestion and fewer heart failure events.
Essential aspects of ultrafiltration remain poorly defined. Further research is urgently needed,
given the burden of congestion and data suggesting sustained benefits of early and adjustable
ultrafiltration.