Acute heart failure with deteriorating renal function: no role found for ultrafiltration

Deteriorating renal function in patients with heart failure is a common situation, affecting approximately a third of patients presenting with acute pulmonary oedema, and is associated with worse outcomes. Due to the potentially nephrotoxic nature of many heart failure therapies, renal failure leads to difficult treatment decisions regarding ongoing diuretic therapy. Few options yet exist in this challenging clinical situation, however one potential option is mechanical ultrafiltration devices but currently there is a lack of evidence to support their use.

In this multicenter, randomised, open-label study a total of 188 patients with acute decompensated heart failure, worsened renal function, and persistent congestion were allocated in a 1:1 fashion either to a strategy of stepped pharmacologic therapy or ultrafiltration. The primary end point was the bivariate change from baseline in the serum creatinine level and body weight, as assessed 96 h after group assignment with patients followed for a total of 60 days. The results did not …