Treatment of congestion in congestive heart failure: Ultrafiltration is the only rational initial Treatment of volume overload in decompensated heart failure

The morbidity of decompensated heart failure is due to volume overload, a consequence of increased total body sodium. Treatments that do not adequately reduce total body sodium are ineffective. As a result, using diuretics to produce hypotonic urine or other agents to achieve hemodynamic targets will not lead to improved clinical outcomes. Ultrafiltration is the gold standard for sodiumvolume removal and is the only intervention shown to improve outcomes in a randomized controlled trial of patients hospitalized with decompensated heart failure. The success of any new intervention designed to improve outcomes in this patient population should be measured against ultrafiltration.