Recommendation 126: We do not recommend the routine use of ultrafiltration for the management of intractable edema in decompensated heart failure (Weak Recommendation, Low Quality Evidence).

While the routine use of ultrafiltration for volume and symptom control in heart failure is not supported by trial evidence, it could be tried in refractory cases where stepped pharmacologic therapy has failed. All forms of UF should be avoided unless it is used, as a last resort for symptom control in a center well versed in its use with the understanding that it could further compromise renal function and that the benefits are short lived.