An estimated 4.8 million Americans are diagnosed with heart failure. Of those, 5% to 10% meet criteria for the refractory state of the disease. While therapeutic interventions continue to evolve with the changing conceptualization of heart failure pathophysiology, overhydration and its deleterious sequelae remain a problem for those in the refractory state. The incidence of heart failure continues to rise in older individuals. As baby-boomers age across America, greater focus on new, more effective therapies must be considered for treatment of this disease. Continuous renal replacement therapy (CRRT) is one such treatment. The gentle removal of fluid and metabolites while maintaining electrolyte balance helps reduce the effects of overhydration in patients with heart failure. Increasing use of the therapy in the refractory state of heart failure is generating support for early initiation as it continues to demonstrate positive effects. Reduction in edema, attenuation of the sympathoadrenal cascade, and improved respiratory status have all been documented using the therapy.

The intent of this article is to provide information for advanced practice nurses and direct care providers regarding CRRT for the treatment of heart failure refractory to typical therapy.

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