Heart failure (HF) is a major public health problem with a prevalence of more than 23 million worldwide(Roger VL: Epidemiology of heart failure. Circ Res 2013). Acute decompensated HF (ADHF), defined as 'gradual or rapid change in HF signs and symptoms resulting in a need for urgent therapy', with associated volume overload is the most common cause of hospitalization in heart failure patients. When it is accompanied by worsening in renal function, it is described as a cardio-renal syndrome and is a therapeutic challenge(Acute heart failure syndromes: current state and framework for future research. Circulation 2005). In spite of the major advances in chronic HF management, the morbidity and mortality of ADHF remain high, resulting in the significant impairment of the quality of life of the patients and high health care cost burden. Congestion is the primary reason for hospitalization in a great majority of patients with ADHF. Moreover, adequate decongestion determined by either invasive or noninvasive parameters has been linked with improved outcomes in these patients. Currently available therapeutic regimens for decongestion, which heavily rely on diuretic use, are associated with a number of shortcomings. Diuretics are known to cause electrolyte abnormalities, deterioration of renal function, neuro hormonal activation, and non-renal adverse effects. Suboptimal diuresis, diuretic resistance, and unpredictability of the therapeutic response pose additional challenges for the use of these medications in the setting of ADHF, which in turn lead to worsening or lingering congestion(Gheorghiade M, Filippatos G: Reassessing treatment of acute heart failure syndromes: the ADHERE Registry. Eur Heart J Suppl 2005). Unfortunately, the newer pharmacologic agents such as endothelin receptor antagonists, vasopressin receptor antagonists, and adenosine-A1 receptor antagonists have failed to prove their role as safe and effective alternatives to conventional therapies. Consequently, there has been a renewed interest in exploring non-pharmacologic therapies like mechanical extraction of the excess fluid (i.e. ultrafiltration (UF)) as an effective alternative to the conventional approaches aimed at decongestion in ADHF. Ultrafiltration is a mechanical fluid removal procedure designed to treat patients who have an excess of fluid in their bodies and have difficulty removing fluid with diuretics. The goal of treatment is to restore fluid balance in the body. UF therapy has several proposed advantages including relatively rapid, predictable, and adjustable fluid removal, activation of the renin-angiotensin-aldosterone system to a lower degree compared with diuretics, and more effective sodium removal.