Ultrafiltration and other treatments of volume overload in congestive heart failure

Abstract Heart failure (HF) is a significant public health problem worldwide due to its prevalence and the substantial economic burden it imposes on the society. While conventional management of HF with loop diuretics remains the cornerstone, patients often develop diuretic resistance and worsening renal function during treatment, which has been linked to adverse outcomes. Although mechanical ultrafiltration (UF) has been used in the treatment of HF for decades, significant interest in its use was recently generated from encouraging published results involving devices with newer technology. Recent trials have evaluated its efficacy and safety as well as practical aspects of its use such as improvement in patients’ symptoms and length of hospital stay. Guidelines from major societies recommend that UF may be considered for patients with refractory congestion not responding to medical therapy. In this chapter, we discuss the role of UF therapy in refractory HF, emphasizing its effect on cardiovascular and renal systems and patient outcomes substantiated by published data. We also briefly discuss novel UF devices that are being developed to facilitate mechanical fluid extraction in HF patients, that are convenient to use even in the outpatient setting.