Published online May 26, 2023. doi: 10.4330/wjc.v15.i5.205
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
Processing time: 142 Days and 13.8 Hours
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.
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.