What is the role of ultrafiltration (UF) for the treatment of cardiogenic pulmonary edema (CPE)?

Updated: Jul 23, 2020
  • Author: Ali A Sovari, MD, FACP, FACC; Chief Editor: Gyanendra K Sharma, MD, FACC, FASE  more...
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Ultrafiltration (UF) is a method of fluid removal that is particularly useful in patients with renal dysfunction and expected diuretic resistance.

The randomized Ultrafiltration Versus Intravenous Diuretics for Patients Hospitalized for Acute Decompensated Heart Failure (UNLOAD) trial demonstrated that ultrafiltration was superior to the use of IV diuretics in controlling net fluid loss and rehospitalization in hypervolemic patients with heart failure. [34] These results indicated that UF should be considered in patients with volume overload and acute CHF who have not responded well to moderate to large doses of diuretic treatment or in whom the adverse effects of such treatment (eg, renal dysfunction) do not allow initiation or continuation of the therapy. 

Use of ultrafiltration in patients with decompensated heart failure and worsening renal function compared to conventional stepwise pharmacotherapy (consisting of diuretics and inotropic agents) is associated with similar diuresis but more impaired renal function at 96 hours following the initiation of treatment. [35]  Therefore, use of ultrafiltration is generally considered after failure of pharmacologic options or when it is known in a particular patient that the clinical response to drugs will be inadequate.

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