The role of ultrafiltration in the management of heart failure.

Congestion causes the majority of hospitalizations for heart failure and contributes to heart failure progression and mortality. Intravenous loop diuretics reduce the signs and symptoms of congestion. Loop diuretics, however, may be associated with increased morbidity and mortality due to deleterious effects on neurohormonal activation, electrolyte balance, and cardiac and renal function. Ultrafiltration, an alternative method of sodium and water removal, safely improves hemodynamics in heart failure patients. Recent clinical trial data suggest that ultrafiltration may also reduce rehospitalizations for worsening heart failure.