SCUF Cardiorenal Syndrome — FRCA Final MCQ

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HardIntensive Care MedicineSCUF Cardiorenal SyndromeFRCA Final

A 72-year-old woman (ASA IV) with decompensated heart failure and cardiorenal syndrome is in the ICU requiring fluid removal. Diuretics have failed. Which modality can provide controlled ultrafiltration without requiring full renal replacement therapy?

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Correct answer: E — Slow continuous ultrafiltration (SCUF)

Slow continuous ultrafiltration (SCUF) removes fluid (plasma water) without significant solute clearance, making it ideal for isolated fluid overload in cardiorenal syndrome when diuretics have failed. It uses a haemofilter with low blood flow rates (50-100 mL/min) and no replacement fluid or dialysate. Fluid removal rates of 100-500 mL/hr can be achieved. The CARRESS-HF trial (2012) compared ultrafiltration to stepped pharmacological therapy for acute decompensated heart failure; results showed no superiority of ultrafiltration but confirmed its role when diuretics fail.

Reference: Bart BA et al – 2012 – CARRESS-HF trial; KDIGO – 2012 – AKI guidelines