Professional Statements and Societal Positions Guidelines
American College of Cardiology Foundation and American Heart Association-2017
The American College of Cardiology Foundation and American Heart Association published joint guidelines (2013) on the diagnosis and management of heart failure in adults (under Recommendations for Hospitalized Patient) that list ultrafiltration as a class IIb recommendation (benefit greater than or equal to risk, additional studies needed). The recommendations indicated that ultrafiltration "may be considered for individuals with obvious volume overload to alleviate congestive symptoms and fluid weight" (level of evidence B: conflicting evidence) and "for individuals with refractory congestion not responding to medical therapy" (level of evidence C: recommendation less well established). A 2017 update from the American College of Cardiology, the American heart Association Task Force on Clinical Practice Guidelines, and the Heart Failure Society of America did not mention ultrafiltration.
European Society of Cardiology and Heart Failure Association – 2016
Ultrafiltration involves the removal of plasma water across a semipermeable membrane in response to a transmembrane pressure gradient. There is no evidence favoring ultrafiltration over loop diuretics as first-line therapy in individuals with AHF. At the present time, routine use of ultrafiltration is not recommended and should be confined to individuals who fail to respond to diuretic based strategies.