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Updated: Jun 11, 2026

Bedside Ultrasound for Guiding Fluid Removal in Patients with Pulmonary Edema: The Reverse-FALLS Protocol
Published on: July 28, 2018
Ultrafiltration versus diuretics in congestive heart failure
Michael F Flessner1, Lajos Zsom, Luis Juncos
1Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA. mfflessner@comcast.net
Abstract:
Acute decompensated heart failure often coexists with renal failure, and together they increase in-hospital mortality. Sometimes either condition arises because of the decompensation of chronic kidney disease or chronic heart failure. High-dose diuretics along with vasodilators and other medications are the standard first-line therapy but are sometimes ineffective because of the development of diuretic resistance or acute kidney injury. Fluid can be removed with different forms of dialytic techniques, but controversy exists about how and when to perform these procedures. This article explores the risks and benefits of technological approaches and the existing evidence for the best course of action.
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