{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T22:47:54Z","timestamp":1785278874106,"version":"3.55.0"},"reference-count":31,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2018,3,1]],"date-time":"2018-03-01T00:00:00Z","timestamp":1519862400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Mechanical ultrafiltration (UF) involves the removal of an iso-osmotic filtrate from the blood. Its benefit in acute decompensated heart failure, however, remains inconclusive. We sought to better understand the direct effects of UF in comparison to an aggressive, urine output-guided pharmacological protocol for decongestion on fluid loss, renal function, and neurohormonal activation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>A per-protocol analysis of the Cardiorenal Rescue Study in Acute Decompensated Heart Failure (CARRESS-HF) trial (n = 188) was performed. Participants were included if randomized to UF and had UF output collected, or if randomized to the pharmacological arm and had urine but not UF output collected. Using these definitions, there were 163 participants at 24 h, 156 at 48 h, 129 at 72 h, and 106 at 96 h. UF was associated with higher cumulative fluid loss (P = 0.003), net fluid loss (P = 0.001), and relative reduction in weight (P = 0.02). UF was also associated with higher serum creatinine and blood urea nitrogen by 72 h (P-interaction &amp;lt;0.05 for both), lower serum sodium by 48 h (P-interaction &amp;lt;0.01) and increased plasma renin activity by 96 h (P = 0.04). The pharmacological arm was associated with higher serum bicarbonate after 24 h (P-interaction &amp;lt;0.002). There were no differences in 60-day outcomes between the UF and pharmacological arms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Ultrafiltration vs. pharmacological therapy was associated with more fluid removal but also rise in serum creatinine and neurohormonal activation. Additionally, loop diuretic use vs. UF was associated with an increase in serum bicarbonate despite less decongestion, data which question the commonly held conception of a \u2018contraction alkalosis\u2019.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ejhf.1158","type":"journal-article","created":{"date-parts":[[2018,3,1]],"date-time":"2018-03-01T02:32:41Z","timestamp":1519871561000},"page":"1148-1156","source":"Crossref","is-referenced-by-count":63,"title":["Direct Comparison of Ultrafiltration to Pharmacological Decongestion in Heart Failure: A Per-Protocol Analysis of CARRESS-HF"],"prefix":"10.1093","volume":"20","author":[{"given":"Justin L.","family":"Grodin","sequence":"first","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center , Dallas, TX ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Spencer","family":"Carter","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Texas Southwestern Medical Center , Dallas, TX ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bradley A.","family":"Bart","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, Hennepin County Medical Center , Minneapolis, MN ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven R.","family":"Goldsmith","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, Hennepin County Medical Center , Minneapolis, MN ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark H.","family":"Drazner","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center , Dallas, TX ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W.H. Wilson","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic , Cleveland, OH ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2018,3,1]]},"reference":[{"key":"2026011721242149700_ejhf1158-bib-0001","doi-asserted-by":"crossref","first-page":"2233","DOI":"10.1016\/j.jacc.2010.10.065","article-title":"Volume status and diuretic therapy in systolic heart failure and the detection of early abnormalities in renal and tubular function","volume":"57","author":"Damman","year":"2011","journal-title":"J Am Coll Cardiol"},{"key":"2026011721242149700_ejhf1158-bib-0002","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1161\/CIRCULATIONAHA.109.933275","article-title":"Potential effects of aggressive decongestion during the treatment of decompensated heart failure on renal function and survival","volume":"122","author":"Testani","year":"2010","journal-title":"Circulation"},{"key":"2026011721242149700_ejhf1158-bib-0003","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1016\/j.jacc.2011.01.052","article-title":"Interaction between loop diuretic-associated mortality and blood urea nitrogen concentration in chronic heart failure","volume":"58","author":"Testani","year":"2011","journal-title":"J Am Coll Cardiol"},{"key":"2026011721242149700_ejhf1158-bib-0004","doi-asserted-by":"crossref","first-page":"1075","DOI":"10.1093\/oxfordjournals.eurheartj.a059429","article-title":"Neuroendocrine response in acute heart failure and the influence of treatment","volume":"10","author":"Broqvist","year":"1989","journal-title":"Eur Heart J"},{"key":"2026011721242149700_ejhf1158-bib-0005","doi-asserted-by":"crossref","first-page":"1014","DOI":"10.1002\/ejhf.757","article-title":"Renal tubular resistance is the primary driver for loop diuretic resistance in acute heart failure","volume":"19","author":"Ter Maaten","year":"2017","journal-title":"Eur J Heart Fail"},{"key":"2026011721242149700_ejhf1158-bib-0006","doi-asserted-by":"crossref","first-page":"2043","DOI":"10.1016\/j.jacc.2005.05.098","article-title":"Ultrafiltration versus usual care for hospitalized patients with heart failure: the Relief for Acutely Fluid-Overloaded Patients With Decompensated Congestive Heart Failure (RAPID-CHF) trial","volume":"46","author":"Bart","year":"2005","journal-title":"J Am Coll Cardiol"},{"key":"2026011721242149700_ejhf1158-bib-0007","doi-asserted-by":"crossref","first-page":"675","DOI":"10.1016\/j.jacc.2006.07.073","article-title":"Ultrafiltration versus intravenous diuretics for patients hospitalized for acute decompensated heart failure","volume":"49","author":"Costanzo","year":"2007","journal-title":"J Am Coll Cardiol"},{"key":"2026011721242149700_ejhf1158-bib-0008","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.cardfail.2013.11.004","article-title":"Continuous ultrafiltration for congestive heart failure: the CUORE trial","volume":"20","author":"Marenzi","year":"2014","journal-title":"J Card Fail"},{"key":"2026011721242149700_ejhf1158-bib-0009","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1093\/eurjhf\/hfq207","article-title":"Effects of ULTRAfiltration vs. DIureticS on clinical, biohumoral and haemodynamic variables in patients with deCOmpensated heart failure: the ULTRADISCO study","volume":"13","author":"Giglioli","year":"2011","journal-title":"Eur J Heart Fail"},{"key":"2026011721242149700_ejhf1158-bib-0010","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.jchf.2015.08.005","article-title":"Aquapheresis versus intravenous diuretics and hospitalizations for heart failure","volume":"4","author":"Costanzo","year":"2016","journal-title":"JACC Heart Fail"},{"key":"2026011721242149700_ejhf1158-bib-0011","doi-asserted-by":"crossref","first-page":"e147","DOI":"10.1016\/j.jacc.2013.05.019","article-title":"2013 ACCF\/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation\/American Heart Association Task Force on Practice Guidelines","volume":"62","author":"Yancy","year":"2013","journal-title":"J Am Coll Cardiol"},{"key":"2026011721242149700_ejhf1158-bib-0012","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1002\/ejhf.592","article-title":"Developed with the special contribution of the Heart Failure Association (HFA) of the ESC","volume":"18","author":"Ponikowski","year":"2016","journal-title":"Eur J Heart Fail"},{"key":"2026011721242149700_ejhf1158-bib-0013","doi-asserted-by":"crossref","first-page":"2296","DOI":"10.1056\/NEJMoa1210357","article-title":"Ultrafiltration in decompensated heart failure with cardiorenal syndrome","volume":"367","author":"Bart","year":"2012","journal-title":"N Engl J Med"},{"key":"2026011721242149700_ejhf1158-bib-0014","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1016\/j.cardfail.2011.12.009","article-title":"Cardiorenal rescue study in acute decompensated heart failure: rationale and design of CARRESS-HF, for the Heart Failure Clinical Research Network","volume":"18","author":"Bart","year":"2012","journal-title":"J Card Fail"},{"key":"2026011721242149700_ejhf1158-bib-0015","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.cardfail.2015.07.007","article-title":"Intensification of medication therapy for cardiorenal syndrome in acute decompensated heart failure","volume":"22","author":"Grodin","year":"2016","journal-title":"J Card Fail"},{"key":"2026011721242149700_ejhf1158-bib-0016","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1038\/ki.1984.153","article-title":"Bumetanide and furosemide in heart failure","volume":"26","author":"Brater","year":"1984","journal-title":"Kidney Int"},{"key":"2026011721242149700_ejhf1158-bib-0017","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1016\/0009-9236(95)90222-8","article-title":"Bioavailability, pharmacokinetics, and pharmacodynamics of torsemide and furosemide in patients with congestive heart failure","volume":"57","author":"Vargo","year":"1995","journal-title":"Clin Pharmacol Ther"},{"key":"2026011721242149700_ejhf1158-bib-0018","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1161\/CIRCHEARTFAILURE.111.963413","article-title":"Is worsening renal function an ominous prognostic sign in patients with acute heart failure? The role of congestion and its interaction with renal function","volume":"5","author":"Metra","year":"2012","journal-title":"Circ Heart Fail"},{"key":"2026011721242149700_ejhf1158-bib-0019","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.cardfail.2007.09.007","article-title":"A randomized, controlled trial of the renal effects of ultrafiltration as compared to furosemide in patients with acute decompensated heart failure","volume":"14","author":"Rogers","year":"2008","journal-title":"J Card Fail"},{"key":"2026011721242149700_ejhf1158-bib-0020","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1054\/jcaf.2003.28","article-title":"Peripherally inserted veno-venous ultrafiltration for rapid treatment of volume overloaded patients","volume":"9","author":"Jaski","year":"2003","journal-title":"J Card Fail"},{"key":"2026011721242149700_ejhf1158-bib-0021","doi-asserted-by":"crossref","first-page":"2428","DOI":"10.1016\/j.jacc.2017.03.528","article-title":"Extracorporeal ultrafiltration for fluid overload in heart failure: current status and prospects for further research","volume":"69","author":"Costanzo","year":"2017","journal-title":"J Am Coll Cardiol"},{"key":"2026011721242149700_ejhf1158-bib-0022","doi-asserted-by":"crossref","first-page":"2351","DOI":"10.1056\/NEJMe1212881","article-title":"Reconsidering ultrafiltration in the acute cardiorenal syndrome","volume":"367","author":"Tang","year":"2012","journal-title":"N Engl J Med"},{"key":"2026011721242149700_ejhf1158-bib-0023","doi-asserted-by":"crossref","first-page":"669","DOI":"10.2215\/CJN.00880207","article-title":"Relative blood volume changes underestimate total blood volume changes during hemodialysis","volume":"2","author":"Dasselaar","year":"2007","journal-title":"Clin J Am Soc Nephrol"},{"key":"2026011721242149700_ejhf1158-bib-0024","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1016\/j.jacc.2014.12.010","article-title":"Hyponatremia in acute decompensated heart failure: depletion versus dilution","volume":"65","author":"Verbrugge","year":"2015","journal-title":"J Am Coll Cardiol"},{"key":"2026011721242149700_ejhf1158-bib-0025","doi-asserted-by":"crossref","first-page":"156","DOI":"10.4070\/kcj.2014.44.3.156","article-title":"A pilot study of target weight guided treatment in acute heart failure using ultrafiltration or usual care: effect on sodium removal","volume":"44","author":"Chung","year":"2014","journal-title":"Korean Circ J"},{"key":"2026011721242149700_ejhf1158-bib-0026","doi-asserted-by":"crossref","first-page":"1635","DOI":"10.1016\/0002-9149(83)90200-X","article-title":"Association of hyponatremia with increased renin activity in chronic congestive heart failure: impact of diuretic therapy","volume":"51","author":"Schaer","year":"1983","journal-title":"Am J Cardiol"},{"key":"2026011721242149700_ejhf1158-bib-0027","first-page":"98P","article-title":"Drinking caused by the intracranial injection of angiotensin into the rat","volume":"200","author":"Epstein","year":"1969","journal-title":"J Physiol"},{"key":"2026011721242149700_ejhf1158-bib-0028","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1161\/01.CIR.63.3.645","article-title":"Relation of the renin\u2013angiotensin\u2013aldosterone system to clinical state in congestive heart failure","volume":"63","author":"Dzau","year":"1981","journal-title":"Circulation"},{"key":"2026011721242149700_ejhf1158-bib-0029","doi-asserted-by":"crossref","first-page":"2002","DOI":"10.1172\/JCI111622","article-title":"Volume-independent reductions in glomerular filtration rate in acute chloride-depletion alkalosis in the rat. Evidence for mediation by tubuloglomerular feedback","volume":"74","author":"Galla","year":"1984","journal-title":"J Clin Invest"},{"issue":"3 Pt 1","key":"2026011721242149700_ejhf1158-bib-0030","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1016\/0002-9343(88)90265-3","article-title":"On the mechanism by which chloride corrects metabolic alkalosis in man","volume":"84","author":"Rosen","year":"1988","journal-title":"Am J Med"},{"key":"2026011721242149700_ejhf1158-bib-0031","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1016\/j.amjcard.2016.09.014","article-title":"Implications of serum chloride homeostasis in acute heart failure (from ROSE-AHF)","volume":"119","author":"Grodin","year":"2017","journal-title":"Am J Cardiol"}],"container-title":["European Journal of Heart Failure"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fejhf.1158","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/academic.oup.com\/eurjhf\/article-pdf\/20\/7\/1148\/66268680\/eurjhf_20_7_1148.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eurjhf\/article-pdf\/20\/7\/1148\/66268680\/eurjhf_20_7_1148.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,18]],"date-time":"2026-01-18T02:26:48Z","timestamp":1768703208000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/eurjhf\/article\/20\/7\/1148\/8414630"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,3,1]]},"references-count":31,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2018,3,1]]},"published-print":{"date-parts":[[2018,7,1]]}},"URL":"https:\/\/doi.org\/10.1002\/ejhf.1158","relation":{},"ISSN":["1388-9842","1879-0844"],"issn-type":[{"value":"1388-9842","type":"print"},{"value":"1879-0844","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2018,7]]},"published":{"date-parts":[[2018,3,1]]}}}