Ultrafiltration as a Therapeutic Option for Refractory Congestive Heart Failure

Chronic kidney disease is frequently associated with cardiovascular disease, particularly among elderly patients, and this combination complicates the management of severe congestive heart failure (CHF).1•² Even with adequate renal function, end-stage cardiomyopathy of any etiology can at times result in severe hemodynamic alterations leading to volume overload that is unresponsive to conventional diuretic therapy.⁷ Moreover, aggressive diuretic programs inevitably lead to acid/base and electrolyte-metabolic imbalance that further compounds the clinical scenario. Simultaneous correction of intractable fluid overload and metabolic disarray in these patients can be achieved by using different ultrafiltration modalities, including continuous venovenous hemofiltration/dialysis, sustained low-efficiency dialysis, sustained continuous ultrafiltration and continuous cyclic peritoneal dialysis. While the duration of these therapies varies, patients who do not have a favorable response within 30 days usually have a poor prognosis.³