Mechanical strategies to improve fluid overload in patients with cardiorenal syndrome

Treatment of acute deterioration in cardiac function traditionally involved diuretics, inotropes, and vasodilators. Usage of diuretics to reduce volume overload and pulmonary edema is often slow and many times accompanied by activation of renin-angiotensin-aldosterone system (RAAS) and sympathetic nervous system (SNS) with resultant increase in serum creatinine and heart rate. Other therapies that have been used in this setting include natriuretics and aquaretics, although with limited success. To address this problem, mechanical removal of fluid (ultrafiltration [UF]/ aquapheresis) in volume-overloaded patients is increasingly being done with lesser incidence of activation of RAAS and SNS. Both traditional dialysis machines and dedicated machines for isolated UF have been employed.