Extracorporeal ultrafiltration for acute heart failure: Patient selection and perspectives

Most patients presenting with acute heart failure (AHF) show signs and symptoms of fluid overload, which are closely associated with short-term and long-term outcomes. Ultrafiltration is an extremely appealing strategy for patients with AHF and concomitant overt fluidoverload not fully responsive to diuretic therapy. However, although there are several theoreticalbeneficial effects associated with ultrafiltration, published reports have shown controversialfindings. Differences in selection of the study population and in ultrafiltration indications andprotocols, and high variability in the pharmacologic therapy used for the control group couldexplain some of these conflicting results. Here, we aimed to provide an overview on the currentmedical evidence supporting the use of ultrafiltration in AHF, with a special focus on the identification of potential candidates who may benefit the most from this therapeutic option.