Decongestive treatment of acute decompensated heart failure: cardiorenal implications of ultrafiltration and diuretics

Am J Kidney Dis. 2011 Dec;58(6):1005-17. doi: 10.1053/j.ajkd.2011.07.023. Epub 2011 Oct 19.


In patients with acute decompensated heart failure (ADHF), treatment aimed at adequate decongestion of the volume overloaded state is essential. Despite diuretic therapy, many patients remain volume overloaded and symptomatic. In addition, adverse effects related to diuretic treatment are common, including worsening kidney function and electrolyte disturbances. The development of decreased kidney function during treatment affects the response to diuretic therapy and is associated with important clinical outcomes, including mortality. The occurrence of diuretic resistance and the morbidity and mortality associated with diuretic therapy has stimulated interest to develop effective and safe treatment strategies that maximize decongestion and minimize decreased kidney function. During the last few decades, extracorporeal ultrafiltration has been used to remove fluid from diuretic-refractory hypervolemic patients. Recent clinical studies using user-friendly machines have suggested that ultrafiltration may be highly effective for decongesting patients with ADHF. Many questions remain regarding the comparative impact of diuretics and ultrafiltration on important clinical outcomes and adverse effects, including decreased kidney function. This article serves as a summary of key clinical studies addressing these points. The overall goal is to assist practicing clinicians who are contemplating the use of ultrafiltration for a patient with ADHF.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Arteriovenous Shunt, Surgical
  • Cardio-Renal Syndrome / physiopathology
  • Cardio-Renal Syndrome / therapy
  • Creatinine / blood
  • Diuretics / administration & dosage
  • Diuretics / therapeutic use*
  • Furosemide / administration & dosage
  • Glomerular Filtration Rate / physiology
  • Heart Failure / etiology
  • Heart Failure / mortality
  • Heart Failure / physiopathology
  • Heart Failure / therapy*
  • Humans
  • Infusions, Intravenous
  • Kidney / physiopathology
  • Length of Stay
  • Male
  • Middle Aged
  • Myocardial Ischemia / complications
  • Peritoneal Dialysis
  • Potassium / blood
  • Risk Factors
  • Sodium Potassium Chloride Symporter Inhibitors / administration & dosage
  • Treatment Outcome
  • Ultrafiltration


  • Diuretics
  • Sodium Potassium Chloride Symporter Inhibitors
  • Furosemide
  • Creatinine
  • Potassium