Isolated ultrafiltration in heart failure patients

Most heart failure hospitalizations are due to volume overload, which contributes to disease progression. Heart failure decompensation is typically treated with intravenous diuretics, which are of limited efficacy especially in patients with underlying chronic kidney disease. Since the introduction of hemodialysis, ultrafiltration has been used to remove excess body fluid. Newer, simplified isolated ultrafiltration devices make ultrafiltration feasible at most hospitals and in less acute care settings. Veno-venous ultrafiltration is characterized by transport of solutes and water across a semipermeable membrane in response to a transmembrane pressure gradient generated by a peristaltic pump. Monitoring of ultrafiltration requires a combination of clinical and biomarkers values. Hemodynamic instability due to overaggressive fluid removal must be avoided. Based on recent clinical trials, practice guidelines state that ultrafiltration is reasonable for patients with congestion refractory to medical therapy (Class IIa, Level of Evidence B). Unanswered questions regarding ultrafiltration in heart failure patients include optimal fluid removal rates, effect on long-term survival, and cost.