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International Journal of Nephrology
Volume 2011 (2011), Article ID 190230, 6 pages
http://dx.doi.org/10.4061/2011/190230
Review Article

The Role of Ultrafiltration in Patients with Decompensated Heart Failure

Division of Cardiovascular Medicine, University of Virginia Health System, P.O. Box 800158, Charlottesville, VA 22908, USA

Received 15 August 2010; Accepted 1 September 2010

Academic Editor: Mitchell H. Rosner

Copyright © 2011 Sandeep A. Kamath. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Congestion, due in large part to hypervolemia, is the primary driver of heart failure (HF) admissions. Relief of congestion has been traditionally achieved through the use of loop diuretics, but there is increasing concern that these agents, particularly at high doses, may be deleterious in the inpatient setting. In addition, patients with HF and the cardiorenal syndrome (CRS) have diminished response to loop diuretics, making these agents less effective at relieving congestion. Ultrafiltration, a mechanical volume removal strategy, has demonstrated promise in achieving safe and effective volume removal in patients with cardiorenal syndrome and diuretic refractoriness. This paper outlines the rationale for ultrafiltration in CRS and the available evidence regarding its use in patients with HF. At present, the utility of ultrafiltration is restricted to selected populations, but a greater understanding of how this technology impacts HF and CRS may expand its use.