Slow continuous ultrafiltration using central vs peripheral line: feasibility of implementation, safety and efficacy in acute heart failure syndromes.

Inclusion Criteria:

• ≥ 18 years
• Patients hospitalized with primary diagnosis of acute heart failure defined as ≥ 2 of the following criteria:
• Peripheral or sacral edema
• Jugular venous distension or venous central pressure > 10 mmHg
• Hepatomegaly or ascites
• Pulmonary edema or pleural effusion on x-ray or pulmonary wedge pressure or end-diastolic pressure > 20 mmHg.
• High pro-BNP
• Randomization during first 24 hours
• Serum creatinine levels < 3mg/dL, and K < 6 mmol/L
• The patient should be able to communicate with research staff and meet with study procedures.
• The patient will signed informed consent.

Exclusion Criteria:

• Diagnosis of severe aortic stenosis or severe obstruction to the LVOT, tamponade, cardiac hypertrophic or restrictive cardiomyopathy.
• Impossibility of venous catheterization
• Acute coronary syndrome
• Creatinine greater than 3.0 or K greater than 6 mmol/L.
• Systolic blood pressure less than or equal to 100 mmHg
• Hematocrit greater than 45%
• Prior administration of IV vasoactive drugs in the emergency room (ER)
• Clinical instability requiring pressors during hospitalization
• Sepsis
• On or requires renal dialysis.