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World J Cardiol. May 26, 2023; 15(5): 205-216
Published online May 26, 2023. doi: 10.4330/wjc.v15.i5.205
Extracorporeal veno-venous ultrafiltration in congestive heart failure: What’s the state of the art? A mini-review
Andrea Urbani, Filippo Pensotti, Andrea Provera, Andrea Galassi, Marco Guazzi, Diego Castini
Andrea Urbani, Filippo Pensotti, Andrea Provera, Marco Guazzi, Diego Castini, Cardiology Unit, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan 20142, Italy
Andrea Galassi, Nephrology Unit, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan 20142, Italy
Author contributions: All authors have made contributions to conception and design of this review, engaged in preparing the article or revising it analytically for essential intellectual content, gave final approval of the version to be published; and agree to be accountable for all aspects of the work.
Conflict-of-interest statement: The authors declare no conflict of interest regarding this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Andrea Urbani, MD, Staff Physician, Cardiology Department, San Paolo Hospital, University of Milan, Via Di Rudinì 8, Milan 20142, Italy. andrea.urbani@unimi.it
Received: December 27, 2022
Peer-review started: December 27, 2022
First decision: January 9, 2023
Revised: January 19, 2023
Accepted: April 24, 2023
Article in press: April 24, 2023
Published online: May 26, 2023
Abstract

Hospitalizations for heart failure exceed 1 million per year in both the United States and Europe and more than 90% are due to symptoms and signs of fluid overload. Rates of rehospitalizations or emergency department visit at 60 days are remarkable regardless of whether loop diuretics were administered at low vs high doses or by bolus injection vs continuous infusion. Ultrafiltration (UF) has been considered a promising alternative to stepped diuretic therapy and it consists in the mechanical, adjustable removal of iso-tonic plasma water across a semipermeable membrane with the application of hydrostatic pressure gradient generated by a pump. Fluid removal with ultrafiltration presents several advantages such as elimination of higher amount of sodium with less neurohormonal activation. However, the conflicting results from UF studies highlight that patient selection and fluid removal targets are not completely understood. The best way to assess fluid status and therefore establish the fluid removal target is also still a matter of debate. Herein, we provide an up-to-date systematic review about the role of ultrafiltration among patients with fluid overload and its gaps in daily practice.

Keywords: Fluid overload, Ultrafiltration, Diuretics, Heart failure

Core Tip: This mini review aimed to evaluate the role of ultrafiltration in congestive heart failure and to compare this approach to standard therapy essentially based on diuretics. Evidences are still controversial and matter of debate, however it is clear that the use of ultrafiltration has beneficial effects on outcomes such as rehospitalization for heart failure and symptoms attenuation. This review of the literature also highlighted the pivotal role of a non-invasive multiparametric assessment of fluid overload to guide physicians through tailoring patient's decongestion.