Table 2.

Inclusion and Exclusion Criteria

Inclusion Criteria Age ≥18 y Admitted to hospital with a primary diagnosis of decompensated heart failure Onset of cardiorenal syndrome (increasing creatinine ≥0.3 mg/dL) after hospitalization or before hospitalization After hospitalization—within 7 days from the time of admission after receiving intravenous diuretics Before hospitalization—within 6 weeks of the index hospitalization in the setting of escalating doses of outpatient loop diuretics Persistent volume overload For patients with a pulmonary artery catheter, persistent volume overload will include: Pulmonary capillary wedge pressure >22 mm Hg and one of the following clinical signs: ≥2+ peripheral edema and/or pulmonary edema or pleural effusions on chest x-ray For patients without a pulmonary artery catheter, persistent volume overload will include at least 2 of the following: ≥2+ peripheral edema, jugular venous pressure >10 mm Hg, and pulmonary edema or pleural effusions on chest x-ray

Exclusion Criteria Intravascular volume depletion Acute coronary syndrome within 4 weeks Indication for hemodialysis Creatinine >3.5 mg/dL at admission to the hospital Systolic blood pressure <90 mm Hg at time of enrollment Alternate explanation for worsening renal function, such as obstructive nephropathy, contrast induced nephropathy, acute tubular necrosis Hematocrit >45% Poor venous access Clinical instability likely to require the addition of intravenous vasoactive drugs including vasodilators and/or inotropic agents Allergy or contraindications to the use of heparin The use of a iodinated radiocontrast material in the past 72 hours or anticipated use of intravenous contrast during the current hospitalization