Veno-Venous Ultrafiltration for Congestive Heart Failure and Cardiorenal Syndrome

Heart failure and cardiorenal syndrome (CRS) are mainly characterized by extracellular fluid retention and venous congestion. Pathophysiology associates increase in atrial venous pressure to maladaptive activation of reninangiotensin-aldosterone and sympathetic nervous systems. Relief of congestive symptoms is usually achieved by the use of loop diuretics. However, resistance to diuretics may occur early in the course of the disease and may worsen outcome. In these settings, the safe and controlled removal of sodium and water from the whole blood using isolated veno-venous ultrafiltration (UF) represents an interesting therapeutic option. It may improve clinical and hemodynamic presentation and restores neuro-hormonal balance and response to diuretics in congestive heart failure patients. Underlining the key-role of fluid overload and venous congestion, this review presents UF benefits and describes its technical and practical issues in CRS. Despite controversial results, UF current indications and future perspectives in CRS are discussed.