Ultrafiltration in the management of acute decompensated heart failure.

PURPOSE OF REVIEW: Admissions to hospital for acute decompensated heart failure continue to increase and represent a significant burden on both patients' and healthcare resources. The majority of these admissions are for the control of volume overload; however, standard treatment with intravenous diuretics is not always effective and can lead to increased renal morbidity. One alternative to standard therapy is mechanical fluid removal with ultrafiltration, this review will highlight the current evidence and efficacy regarding ultrafiltration use in acute heart failure.

RECENT FINDINGS: Multiple recent clinical trials have demonstrated the safety and feasibility of ultrafiltration in the management of acute heart failure. Ultrafiltration may be more effective at removing fluid than standard diuretic therapy and has been associated with beneficial long-term results. However, it remains to be determined whether ultrafiltration is truly nephroprotective and when and how this therapy is best utilized.

SUMMARY: Ultrafiltration is an attractive alternative to standard diuretic therapy in the management of volume overload from acute heart failure. Further research is needed to confirm the cost-effectiveness and to determine long-term impacts on morbidity and mortality.