FIGURE 3. Volume Management in Patients With Acute Heart Failure and CRS.

Escalating doses of loop diuretics are the first-line of therapy for volume removal, with combination diuretic therapy used for patients who do not respond adequately to loop diuretics (3). A target urine output of 3 to 5 l/day has been used in studies of stepped-diuretic therapy (56,62). Hemodynamic assessment and vasoactive therapy can be helpful in selected patients with poor response to diuretics, with extracorporeal volume removal for patients in whom medical therapy fails. CRRT = continuous renal replacement therapy; RRT = renal replacement therapy; SCUF = slow continuous ultrafiltration; other abbreviations as in Figure 1.