***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 
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    ***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 . ) UNLABELLED Slow continuous ultrafiltration ( SCUF ) , continuous veno venous haemofiltration ( CVVHF ) are alternative to diuretics methods of treatment of patients with chronic heart failure ( CHF ) , edematous syndrome . METHODS Patients of both sexes aged 30 - 82 years with functional class II-IV CHF were included because of decompensation of CHF . R and omization : experiment - 19 patients ,  3 - 4 component therapy plus SCUF or CVVHF ; control - 3 - 4 component therapy plus intravenous furosemide . EXAMINATION I ñ at baseline , II ñ after compensation of CHF . RESULTS Delta weight ( kg ) - experiment -10.1+/-1.08 , control -1.92+/-0.83 , p=0.00001 ; Delta left ventricular ejection fraction - experiment + 10.09+/-2.26 , control + 0.52+/-1.14 , p=0.0007 ; pulmonary artery systolic pressure ( mm Hg ) - experiment -12.32+/-3,43 , control -4.05 + /-2.07 , p=0.029 ; Delta 6 min walk test : experiment + 304.22+/-39.4 , control + 91.91+/-23.4 , p=0.00003 ; Delta glomerular filtration rate - experiment -1.16+/-3.23 , control + 4.44+/-3.68 , p=0.85 ; duration of hospitalization ( days ) - experiment 17.26+/-1.43 , control 17.52+/-1.02 , p=0.59 . We did not observe complications related to renal replacement therapy . CONCLUSION SCUF and CVVHF are safe for patients . In decompensated CHF SCUF and CVVHF provide greater weight reduction and fluid removal than intravenous diuretics , abolish hypervolemia what cause improvement of myocardial contractility OBJECTIVES The AVOID-HF ( Aquapheresis versus Intravenous Diuretics and Hospitalization for Heart Failure ) trial tested the hypothesis that patients hospitalized for HF treated with adjustable ultrafiltration ( AUF )  would have a longer time to first HF event within 90 days after hospital discharge than those receiving adjustable intravenous loop diuretics ( ALD ) .  BACKGROUND Congestion in hospitalized heart failure ( HF ) patients portends unfavorable outcomes . METHODS The AVOID-HF trial , design ed as a multicenter , 1-to-1 r and omized study of 810 hospitalized HF patients , was terminated unilaterally and prematurely by the sponsor ( Baxter Healthcare , Deerfield , Illinois ) after enrollment of 224 patients ( 27.5 % ) .  Aquadex FlexFlow System ( Baxter Healthcare ) was used for AUF . A Clinical Events Committee , blinded to the r and omized treatment , adjudicated whether 90-day events were due to HF . RESULTS A total of 110 patients were r and omized to AUF and 114 to ALD . Baseline characteristics were similar . Estimated days to first HF event for the AUF and ALD group were , respectively , 62 and 34 ( p = 0.106 ) . At 30 days , compared with the ALD group , the AUF group had fewer HF and cardiovascular events . Renal function changes were similar . More AUF patients experienced an adverse effect of special interest ( p = 0.018 ) and a serious study product-related adverse event ( p = 0.026 ) . The 90-day mortality was similar . CONCLUSIONS Compared with the ALD group , the AUF group trended toward a longer time to first HF event within 90 days and fewer HF and cardiovascular events . More patients in the AUF group experienced special interest or serious product-related adverse event . Due to the trial 's untimely termination , additional AUF investigation is warranted Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Background and Objectives In the Ultrafiltration versus Intravenous Diuretics for Patients Hospitalized for Acute Decompensated Heart Failure trial , ultrafiltration ( UF ) removed volume more effectively than usual care ( UC ) . Hypothetically , UF may be superior to UC due to increased sodium ( Na ) removal and less neurohormonal activation . We compared UF and UC in a r and omized pilot trial of target weight guided therapy for acute decompensated heart failure ( ADHF ) . Subjects and Methods Sixteen patients with ADHF were enrolled and target weights established prospect ively , prior to r and omization to UC or UF . UF patients did not receive diuretics and UC patients were all treated with a continuous furosemide drip . All urine and ultrafiltrate were collected and Na concentrations measured . Results Similar volumes were removed in UC and UF groups ( 110105 mL and 107415 mL , respectively ) and the UF group also produced 45325 mL of urine . Na concentration was 138±6 meq/L in the ultrafiltrate , 85±73 meq/L in the UC group 's urine , and 26±23 meq/L in the UF group 's urine . Given the relevant associated volumes , total meq of the Na removed was similar ( 1168 in UC vs. 1216 in UF ) . The UF group produced isotonic ultrafiltrate and a higher volume of dilute urine than anticipated . Conclusion In a r and omized pilot study of target weight guided therapy with UC or UF for ADHF , there were no differences in total volumes or Na removed , and lengths of hospital stays were similar . Isotonic fluid loss by UF was accompanied by the production of very dilute urine 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 Background : There are limited data comparing ultrafiltration with st and ard medical therapy as first-line treatment in patients with severe congestive heart failure ( HF ) . We compared ultrafiltration and conventional therapy in patients hospitalized for HF and overt fluid overload . Methods and Results : Fifty-six patients with congestive HF were r and omized to receive st and ard medical therapy ( control group ; n = 29 ) or ultrafiltration  (  ultrafiltration  group ; = 27 ) . The primary endpoint of the study was rehospitalizations for congestive HF during a 1-year follow-up . Despite similar body weight reduction at hospital discharge in the 2 groups ( 7.5 ± 4.5 and 7.9 ± 5.0 kg , respectively;P = .75 ) , a lower incidence of rehospitalizations for HF was observed in the ultrafiltration-treated patients during the following year ( hazard ratio 0.14 , 95 % confidence interval 0.04 - 0.48 ; P = .002).Ultrafiltration-induced benefit was associated with a more stable renal function , unchanged furosemide dose , and lower B-type natriuretic peptide levels . At 1 year , 7 deaths ( 30 % ) occurred in the ultrafiltration group and 11 ( 44 % ) in the control group ( P = .33 ) . Conclusions : In HF patients with severe fluid overload , first-line treatment with ultrafiltration is associated with a prolonged clinical stabilization and a greater freedom from rehospitalization for congestive HF 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 CONTEXT Vasopressin mediates fluid retention in heart failure .  Tolvaptan , a vasopressin V2 receptor blocker , shows promise for management of heart failure . OBJECTIVE To investigate the effects of tolvaptan initiated in patients hospitalized with heart failure . DESIGN , SETTING , AND PARTICIPANTS The Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study With Tolvaptan ( EVEREST ) , an event-driven , r and omized , double-blind , 
    Output:
    
Ultrafiltration showed significantly higher fluid removal and weight loss .
Ultrafiltration showed reduced 90 days heart failure readmissions and trend towards reduced cumulative hospital readmissions .