***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Ultrafiltration is an alternative strategy to diuretic therapy for the treatment of patients with acute decompensated heart failure . Little is known about the efficacy and safety of ultrafiltration in patients with acute decompensated heart failure complicated by persistent congestion and worsened renal function . METHODS We r and omly assigned a total of 188 patients with acute decompensated heart failure , worsened renal function , and persistent congestion to a strategy of stepped pharmacologic therapy ( 94 patients ) or ultrafiltration ( 94 patients ) . The primary end point was the bivariate change from baseline in the serum creatinine level and body weight , as assessed 96 hours after r and om assignment . Patients were followed for 60 days . RESULTS Ultrafiltration was inferior to pharmacologic therapy with respect to the bivariate end point of the change in the serum creatinine level and body weight 96 hours after enrollment ( P=0.003 ) , owing primarily to an increase in the creatinine level in the ultrafiltration group . At 96 hours , the mean change in the creatinine level was -0.04±0.53 mg per deciliter ( -3.5±46.9 μmol per liter ) in the pharmacologic-therapy group , as compared with + 0.23±0.70 mg per deciliter ( 20.3±61.9 μmol per liter ) in the ultrafiltration group ( P=0.003 ) . There was no significant difference in weight loss 96 hours after enrollment between patients in the pharmacologic-therapy group and those in the ultrafiltration group ( a loss of 5.5±5.1 kg [ 12.1±11.3 lb ] and 5.7±3.9 kg [ 12.6±8.5 lb ] , respectively ; P=0.58 ) . A higher percentage of patients in the ultrafiltration group than in the pharmacologic-therapy group had a serious adverse event ( 72 % vs. 57 % , P=0.03 ) . CONCLUSIONS In a r and omized trial involving patients hospitalized for acute decompensated heart failure , worsened renal function , and persistent congestion , the use of a stepped pharmacologic-therapy algorithm was superior to a strategy of ultrafiltration for the preservation of renal function at 96 hours , with a similar amount of weight loss with the two approaches . Ultrafiltration was associated with a higher rate of adverse events . ( Funded by the National Heart , Lung , and Blood Institute ; Clinical Trials.gov number , NCT00608491 . ) We investigated exercise capacity after fluid depletion in patients with moderate congestive heart failure ( CHF ) . Twenty-one patients underwent ultrafiltration ( mean volume + /- SEM : 1,770 + /- 135 ml ) . Echocardiography , tests of pulmonary function , and a cardiopulmonary exercise test with hemodynamic and esophageal pressure monitoring were performed before ultrafiltration and 3 months later . Tests without invasive measurements were repeated 4 and 30 days after ultrafiltration . Twenty-one control patients followed the same protocol but did not have ultrafiltration . Patients who underwent ultrafiltration and increased their oxygen consumption at peak exercise ( peak VO2 ) by > 10 % at the 3-month evaluation ( group A1 , n = 9 ) were separated from those who did not ( group A2 , n = 8) ; 3 patients did not complete the follow-up . Four days after the procedure , peak VO2 had risen from 17.3 + /- 0.8 to 19.3 + /- 0.9 ml/min/kg in group A1 , and from 11.9 + /- 0.7 to 14.1 + /- 0.7 ml/min/kg in group A2 ( p < 0.01 ) . Plasma norepinephrine and pulmonary function were consistent with a greater severity of the syndrome in group A2 . At 3 months in group A1 , the relations of filling pressure to cardiac index of the right and left ventricles were shifted upward ; the esophageal pressure swing ( differences between end-expiratory and end-inspiratory pressure ) for a given tidal volume was lower ; the peak exercise dynamic lung compliance had increased from 0.10 + /- 0.05 to 0.14 + /- 0.03 L/mm Hg ( p < 0.01 ) . None of these changes were detected in group A2 and control patients . ( ABSTRACT TRUNCATED AT 250 WORDS BACKGROUND Loop diuretics are an essential component of therapy for patients with acute decompensated heart failure , but there are few prospect i ve data to guide their use . METHODS In a prospect i ve , double-blind , r and omized trial , we assigned 308 patients with acute decompensated heart failure to receive furosemide administered intravenously by means of either a bolus every 12 hours or continuous infusion and at either a low dose ( equivalent to the patient 's previous oral dose ) or a high dose ( 2.5 times the previous oral dose ) . The protocol allowed specified dose adjustments after 48 hours . The co primary end points were patients ' global assessment of symptoms , quantified as the area under the curve ( AUC ) of the score on a visual-analogue scale over the course of 72 hours , and the change in the serum creatinine level from baseline to 72 hours . RESULTS In the comparison of bolus with continuous infusion , there was no significant difference in patients ' global assessment of symptoms ( mean AUC , 4236±1440 and 4373±1404 , respectively ; P=0.47 ) or in the mean change in the creatinine level ( 0.05±0.3 mg per deciliter [ 4.4±26.5 μmol per liter ] and 0.07±0.3 mg per deciliter [ 6.2±26.5 μmol per liter ] , respectively ; P=0.45 ) . In the comparison of the high-dose strategy with the low-dose strategy , there was a nonsignificant trend toward greater improvement in patients ' global assessment of symptoms in the high-dose group ( mean AUC , 4430±1401 vs. 4171±1436 ; P=0.06 ) . There was no significant difference between these groups in the mean change in the creatinine level ( 0.08±0.3 mg per deciliter [ 7.1±26.5 μmol per liter ] with the high-dose strategy and 0.04±0.3 mg per deciliter [ 3.5±26.5 μmol per liter ] with the low-dose strategy , P=0.21 ) . The high-dose strategy was associated with greater diuresis and more favorable outcomes in some secondary measures but also with transient worsening of renal function . CONCLUSIONS Among patients with acute decompensated heart failure , there were no significant differences in patients ' global assessment of symptoms or in the change in renal function when diuretic therapy was administered by bolus as compared with continuous infusion or at a high dose as compared with a low dose . ( Funded by the National Heart , Lung , and Blood Institute ; Clinical Trials.gov number , NCT00577135 . ) OBJECTIVES The purpose of this research was to assess the safety and efficacy of ultrafiltration ( UF ) in patients admitted with decompensated congestive heart failure ( CHF ) . BACKGROUND Ultrafiltration for CHF is usually reserved for patients with renal failure or those unresponsive to pharmacologic management . We performed a r and omized trial of UF versus usual medical care using a simple UF device that does not require special monitoring or central intravenous access . METHODS Patients admitted for CHF with evidence of volume overload were r and omized to a single , 8 h UF session in addition to usual care or usual care alone . The primary end point was weight loss 24 h after the time of enrollment . RESULTS Forty patients were enrolled ( 20 UF , 20 usual care ) . Ultrafiltration was successful in 18 of the 20 patients in the UF group . Fluid removal after 24 h was 4,650 ml and 2,838 ml in the UF and usual care groups , respectively ( p = 0.001 ) . Weight loss after 24 h , the primary end point , was 2.5 kg and 1.86 kg in the UF and usual care groups , respectively ( p = 0.240 ) . Patients tolerated  UF well . CONCLUSIONS The early application of UF for patients with CHF was feasible , well-tolerated , and result ed in significant weight loss and fluid removal . A larger trial is underway to determine the relative efficacy of UF versus st and ard care in acute decompensated heart failure OBJECTIVE --To investigate the pathophysiological ( cardiac function and physical performance ) significance of clinical ly silent interstitial lung water accumulation in patients with moderate heart failure ; to use isolated ultrafiltration as a means of extravascular fluid reabsorption . DESIGN --Echocardiographic , Doppler , chest x-ray evaluations , and cardiopulmonary tests at baseline , soon after ultrafiltration ( veno venous extracorporeal circuit ) , and four days , one month , and three months later . SETTING --University institute of cardiology . SUBJECTS--24 patients with heart failure due to idiopathic dilated cardiomyopathy or ischaemic myocardial disease with sinus rhythm and ejection fraction less than 35 % . Twelve were r and omised to ultrafiltration  and 12 were taken as controls .  MAIN OUTCOME MEASURES --Left ventricular systolic function ( from ultrasonography ) ; Doppler evaluation of mitral , tricuspid , and aortic flow and echo-Doppler determination of cardiac output ; radiological score of extravascular lung water ; right and left ventricular filling pressures ; oxygen consumption at peak exercise and exercise tolerance time in cardiopulmonary tests . RESULTS --Soon after ultrafiltration ( 1976 ( 760 ) ml of fluid removed ) the following was observed : a reduction in radiological score of extravascular lung water ( from 15(1 ) to 9(1 ) ) and of right ( from 7.1 ( 2.3 ) to 2.3 ( 1.7 ) mm Hg ) and left ( from 17.6 ( 8.8 ) to 9.5 ( 6.4 ) mm Hg ) ventricular filling pressures ; an increase in oxygen consumption at peak exercise ( from 15.8 ( 3.3 ) to 17.6 ( 2 ) ml/min/kg ) and of tolerance time ( from 444 ( 138 ) to 508 ( 134 ) s ) ; a slight decrease in atrial and ventricular dimensions ; no changes in the systolic function of the left ventricle ; a reduction of the early to late filling ratio in both ventricles ( mitral valve from 2 ( 2 ) to 1.1 ( 1.1 ) ) ; ( tricuspid valve from 1.3 ( 1.3 ) to 0.69 ( 0.18 ) ) and an increase in the deceleration time of mitral and tricuspid flow , reflecting a redistribution of filling to late diastole . Variations in the ventricular filling pattern , lung water content , and functional performance persisted for three months in all cases . None of these changes was detected in the control group . CONCLUSIONS --Reduction of interstitial lung water was probably the mechanism whereby ultrafiltration modified the pattern of filling of the two ventricles and improved functional performance Compared with conventional diuretic ( CD ) therapy , ultrafiltration ( UF ) is associated with greater weight loss and fewer re-hospitalizations in patients admitted with decompensated heart failure ( HF ) . Concerns have been raised regarding its safety and efficacy in patients with more advanced heart failure . The authors conducted a single-center , prospect i ve , r and omized controlled trial in patients with advanced HF admitted to an intensive care unit for hemodynamically guided therapy , comparing  UF ( n=17 ) with CD ( n=19 ) at admission . The primary end point was the time required for pulmonary capillary wedge pressure ( PCWP ) to be maintained at a value of ≤18 mm Hg for at least 4 consecutive hours . Secondary end points included levels of cytokines and neurohormones , as well as several clinical outcomes . In our study cohort , the time to achieve the primary end point was lower in the UF group but did not reach statistical significance ( P = .08 ) . UF result ed in greater weight reduction , higher total volume removed , and shorter hospital length of stay . There were no differences in kidney function , biomarkers , or adverse events . In patients with advanced HF under hemodynamically tailored therapy , UF can be safely performed to achieve higher average volume removed  than CD therapy without leading to adverse outcomes OBJECTIVES This study was design ed to compare the safety and efficacy of veno-venous ultrafiltration and st and ard intravenous diuretic therapy for hypervolemic heart failure ( HF ) patients . BACKGROUND Early ultrafiltration may be an alternative to intravenous diuretics in patients with decompensated HF and volume overload . METHODS Patients hospitalized for HF with > or = 2 signs of hypervolemia were r and omized to ultrafiltration or intravenous diuretics . Primary end points were weight loss and dyspnea assessment at 48 h after r and omization . Secondary end points included 
    Output:
    
For patients with ADHF , UF is effective in reducing fluid retention and body weight , with no significant benefits in mortality or rehospitalization .