Ultrafiltration vs Diuretics CARRESS-HF — EECC MCQ

Correct answer: B — The CARRESS-HF trial showed that stepped pharmacological diuretic therapy was superior to ultrafiltration for weight loss and had fewer adverse events — ultrafiltration is reserved as a rescue strategy for truly refractory congestion, not as routine first-line

Ultrafiltration (UF) mechanically removes plasma water from the blood using an extracorporeal circuit — it removes isotonic fluid (unlike diuretics which produce hypotonic urine, losing relatively more water than sodium). The CARRESS-HF trial (2012) compared UF vs stepped diuretic therapy in acute HF with congestion and worsening renal function: stepped diuretics achieved greater weight loss with fewer adverse events (including renal function preservation) than UF. The AVOID-HF trial was stopped early for futility. The ESC 2023 HF Guidelines position UF as a rescue strategy (Class IIb) for: (1) true diuretic resistance (failure of combination IV diuretics); (2) refractory congestion with progressive renal failure; (3) patients requiring emergent volume removal (anuria). It is NOT recommended as routine first-line treatment.

Reference: ESC (2023): HF Guidelines; CARRESS-HF Trial