***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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    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 . ) BACKGROUND Contrast nephropathy ( CN ) is a common cause of renal dysfunction that may be prevented by saline hydration and by drugs such as theophylline or furosemide . Whether oral saline hydration is as efficient as intravenous saline hydration is unknown . The preventive efficacy of theophylline and furosemide for CN remains controversial . The purpose of the current study was to evaluate the efficacy of oral saline hydration and of intravenous saline hydration plus theophylline or furosemide for the prevention of CN . METHODS We prospect ively studied 312 patients with chronic renal failure ( serum creatinine 201+/-81 micromol/l , Cockcroft clearance 37+/-12 ml/min/1.73 m(2 ) ) , who were undergoing various radiological procedures with a non-ionic , low osmolality contrast agent . Patients were r and omly assigned to four arms . In arm A , patients received 1 g/10 kg of body weight/day of sodium chloride per os for 2 days before the procedure . In arm B , patients received 0.9 % saline intravenously at a rate of 15 ml/kg for 6 h before the procedure . In arm C , patients received the same saline hydration as in arm B plus 5 mg/kg theophylline per os in one dose 1 h before the procedure . In arm D , patients received the same saline hydration as in arm B plus 3 mg/kg of furosemide intravenously just after the procedure . RESULTS Patients were well-matched with no significant differences at baseline in any measured parameters .  Acute renal failure , defined as an increase in serum creatinine of 44 micromol/l ( 0.5 mg/dl ) , occurred in 27 out of 312 patients ( 8.7 % ) . There was no significant difference between the rate of renal failure in the different arms of the study : five out of 76 ( 6.6 % ) in arm A , four out of 77 ( 5.2 % ) in arm B , six out of 80 ( 7.5 % ) in arm C and 12 out of 79 ( 15.2 % ) in arm D. No patient had fluid overload or a significant increase in blood pressure in the 2 days following the radiological procedure . The independent predictors of CN were diabetes mellitus , high baseline serum creatinine and high systolic blood pressure . CONCLUSIONS Oral saline hydration was as efficient as intravenous saline hydration for the prevention of CN in patients with stage 3 renal diseases . Furosemide and theophylline were not protective BACKGROUND The treatment of acute decompensated heart failure remains problematic and most often requires parenteral therapies . Significant concerns have been expressed regarding risks and benefits of individual therapies , especially nesiritide ( NES ) , but few studies have compared the relative safety of varied intravenous therapies on clinical outcomes . METHODS We compared the safety of intravenous diuretics ( DIUR ) , inotropes ( INO ) , and vasodilators ( nitroglycerin [ NTG ] ) on mortality rates and worsening renal function in 99,963 in patients with acutely decompensated heart failure ( ADHF ) . Patients with a diagnosis of ADHF within 48 hours were grouped by intended primary treatment ( intravenous agents administered during the first 2 hours of intravenous therapy ) . Treatments studied were ( a ) intended monotherapy ( DIUR ) , ( b ) intended combination therapy ( DIUR + NES , NTG , or INO ) , and ( c ) sequential therapy ( intended DIUR monotherapy followed by a second agent administered > 2 hours later ) . Propensity-matched cohorts and instrumental analysis were used to adjust for differences among patients in treatment groups . RESULTS Intended DIUR monotherapy yielded an unadjusted inpatient mortality rate of 3.2 % . After intended DIUR monotherapy , inpatient mortality was not higher for sequential use of NES than for sequential use of NTG ( 3.4 % vs 6.2 % , P = .0028 ) . In all regimens , INOs were associated with higher inpatient mortality than were diuretics or vasodilators used alone . The rate of worsening renal function was higher with combination of diuretic-based regimens with NES ( risk ratio 1.44 , P < .0001 ) or NTG ( RR 1.2 , P = .012 ) compared with diuretics alone . CONCLUSIONS Compared with alternative intravenous regimens , administration of vasodilators , including NES , was not associated with increased inpatient mortality . A large r and omized controlled clinical trial is being planned to prospect ively address the question of risks and benefits of NES for ADHF 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 Background — The RenalGuard System , which creates high urine output and fluid balancing , may be beneficial in preventing contrast-induced acute kidney injury . Methods and Results — The Renal Insufficiency After Contrast Media Administration Trial II ( REMEDIAL II ) trial is a r and omized , multicenter , investigator-driven trial addressing the prevention of contrast-induced acute kidney injury in high-risk patients . Patients with an estimated glomerular filtration rate ⩽30 mL · min−1 · 1.73 m−2 and /or a risk score ≥11 were r and omly assigned to sodium bicarbonate solution and N-acetylcysteine ( control group ) or hydration with saline and N-acetylcysteine controlled by the RenalGuard System and furosemide ( RenalGuard group ) . The primary end point was an increase of ≥0.3 mg/dL in the serum creatinine concentration at 48 hours after the procedure . The secondary end points included serum cystatin C kinetics and rate of in-hospital dialysis . Contrast-induced acute kidney injury occurred in 16 of 146 patients in the RenalGuard group ( 11 % ) and in 30 of 146 patients in the control group ( 20.5 % ; odds ratio , 0.47 ; 95 % confidence interval , 0.24 to 0.92 ) . There were 142 patients ( 48.5 % ) with an estimated glomerular filtration rate ⩽30 mL · min−1 · 1.73 and 149 patients ( 51.5 % ) with only a risk score ≥11 . Subgroup analysis according to inclusion criteria showed a similarly lower risk of adverse events ( estimated glomerular filtration rate ⩽30 mL · min−1 · 1.73 m−2 : odds ratio , 0.44 ; risk score ≥11 : odds ratio , 0.45 ; P for interaction=0.97 ) . Changes in cystatin C at 24 hours ( 0.02±0.32 versus −0.08±0.26 ; P=0.002 ) and 48 hours ( 0.12±0.42 versus 0.03±0.31 ; P=0.001 ) and the rate of in-hospital dialysis ( 4.1 % versus 0.7 % ; P=0.056 ) were higher in the control group . Conclusion — RenalGuard therapy is superior to sodium bicarbonate and N-acetylcysteine in preventing contrast-induced acute kidney injury in high-risk patients . Clinical Trial Registration — URL : http://www . clinical trial.gov . Unique identifier : NCT01098032 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 ; n = 27 ) . The primary end point 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 ± 5.5 and 7.9 ± 9.0 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 
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Conclusions Furosemide administration has neither an impact on mortality nor the requirement for RRT .
Patients at risk of CIN may benefit from furosemide administration .