Ultrafiltration in Acute Heart Failure: Implications of Ejection Fraction and Early Response to Treatment From CARRESS-HF

Marat Fudim*, Jeremy Brooksbank, Anna Giczewska, Stephen J. Greene, Justin L. Grodin, Pieter Martens, Jozine M. Ter Maaten, Abhinav Sharma, Frederik H. Verbrugge, Hrishikesh Chakraborty, Bradley A. Bart, Javed Butler, Adrian F. Hernandez, G. Michael Felker, Robert J. Mentz

*Corresponding author for this work

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    Ultrafiltration is not commonly used because of higher incidence of worsening renal function without improved decongestion. We examined differential outcomes of high versus low fluid removal and preserved versus reduced ejection fraction (EF) in CARRESS-HF (Cardiorenal Rescue Study in Acute Decompensated Heart Failure).

    Methods and Results

    Baseline characteristics in the ultrafiltration arm were compared according to 24-hour ultrafiltration-based fluid removal above versus below the median. Patients were stratified by EF (40%). We compared clinical parameters of clinical decongestion during the hospitalization based on initial (40% group demonstrated larger increases of change in creatinine (P=0.023) and aldosterone (P=0.038) from baseline to 96 hours. Among patients with EF >40%, those with above median fluid removal (n=17) when compared with below median (n=17) had an increased rate of the combined end point (87.5% versus 47.1%, P=0.014).


    In patients with acute heart failure, higher initial fluid removal with ultrafiltration had no association with worsening renal function. In patients with EF >40%, ultrafiltration was associated with worsening renal function irrespective of fluid removal rate and higher initial fluid removal was associated with higher rates of adverse clinical outcomes, highlighting variable responses to decongestive therapy.

    Original languageEnglish
    Article number015752
    Pages (from-to)1-10
    Number of pages10
    JournalJournal of the American Heart Association
    Issue number24
    Publication statusPublished - 15-Dec-2020


    • congestion
    • heart failure
    • ultrafiltration

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