The case for treating refractory congestive heart failure with ultrafiltration

Extracellular fluid retention and congestion is a fundamental manifestation of heart failure (HF) and cardiorenal syndrome (CRS). Patients are normally hospitalized and treated with diuretics, but their outcomes are often poor as severe congestion and diuretics resistance is the primary cause of HF-related hospital admissions and readmissions. Isolated ultrafiltration (UF), which can be considered as a 'mechanical diuretic and natriuretic' tool, offers promise in achieving safe and effective fluid volume removal in HF patients with CRS who are resistant to stepwise guided diuretic therapy. This paper outlines the rationale for machine-driven isolated UF in CRS and the available clinical evidence regarding its use in patients with HF. In addition, this article summarizes some future clinical perspectives for expanding the use of UF therapy in HF patients in order to improve outcomes.