Diuretics and ultrafiltration in acute decompensated heart failure

J Am Coll Cardiol. 2012 Jun 12;59(24):2145-53. doi: 10.1016/j.jacc.2011.10.910.


Congestion and volume overload are the hallmarks of acute decompensated heart failure (ADHF), and loop diuretics have historically been the cornerstone of treatment. The demonstrated efficacy of loop diuretics in managing congestion is balanced by the recognized limitations of diuretic resistance, neurohormonal activation, and worsening renal function. However, the recently published DOSE (Diuretic Optimization Strategies Evaluation) trial suggests that previous concerns about the safety of high-dose diuretics may not be valid. There has been a growing interest in alternative strategies to manage volume retention in ADHF with improved efficacy and safety profiles. Peripheral venovenous ultrafiltration (UF) represents a potentially promising approach to volume management in ADHF. Small studies suggest that UF may allow for more effective fluid removal compared with diuretics, with improved quality of life and reduced rehospitalization rates. However, further investigation is needed to completely define the role of UF in patients with ADHF. This review summarizes available data on the use of both diuretics and UF in ADHF patients and identifies challenges and unresolved questions for each approach.

Publication types

  • Review

MeSH terms

  • Dopamine / pharmacology
  • Dose-Response Relationship, Drug
  • Glomerular Filtration Rate / drug effects
  • Heart Failure / drug therapy
  • Heart Failure / physiopathology
  • Heart Failure / therapy*
  • Hemofiltration*
  • Humans
  • Mineralocorticoid Receptor Antagonists / pharmacology
  • Sodium Chloride Symporter Inhibitors / pharmacology
  • Sodium Potassium Chloride Symporter Inhibitors / administration & dosage
  • Sodium Potassium Chloride Symporter Inhibitors / pharmacokinetics
  • Sodium Potassium Chloride Symporter Inhibitors / therapeutic use*
  • Treatment Outcome


  • Mineralocorticoid Receptor Antagonists
  • Sodium Chloride Symporter Inhibitors
  • Sodium Potassium Chloride Symporter Inhibitors
  • Dopamine