Therapeutic Ultrafiltration

If your child has severe fluid overload that can't be managed with diuretics, their provider may recommend therapeutic ultrafiltration.

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Fluid overload, also known as hypervolemia, occurs when your child's kidneys retain too much sodium (salt), resulting in excessive amounts of sodium and fluid in the body. This is often caused by heart or kidney failure, as well as various heart and kidney diseases, and can cause swelling, difficulty breathing, and fatigue.

While fluid overload is often managed with diuretics (medications that help the body get rid of extra fluid and sodium through urine), these medications aren't effective for every patient. If your child has severe fluid overload that can't be managed with diuretics, therapeutic ultrafiltration may be your child’s best treatment option.

Therapeutic ultrafiltration is a medical procedure that manages fluid overload using specialized equipment to remove excessive fluid and sodium from the blood while still retaining the essential components of blood. By helping to manage fluid balance, this procedure helps reduce symptoms and improve outcomes for your child.

What sets us apart

University of Iowa Health Care Stead Family Children’s Hospital offers the most comprehensive pediatric cardiology and nephrology services in Iowa and is the only pediatric center in Iowa to offer therapeutic ultrafiltration.

Our dedicated specialists are experts caring for children with complex heart and kidney diseases or failure. They will work with you to create a personalized treatment plan to address your child’s symptoms and bring relief.

How therapeutic ultrafiltration works

If your child is not responding to diuretics, the pediatric intensive care team, pediatric nephrology team, pediatric cardiology, and/or heart failure team may recommend therapeutic ultrafiltration.

Once your child has been admitted (if they were not already admitted), they will be connected to the ultrafiltration device through an IV (intravenous) line and will be given a blood thinner. This device will circulate their blood, slowly removing fluid and excess sodium through a filter in the machine while keeping the essential components of blood.

The benefit of this method over diuretics is that it also removes a larger amount of excess sodium, which is often the reason behind worsening fluid overload. Diuretics often remove some sodium but not a significant amount.

Unless your child has been prescribed around-the-clock treatment, the process will take 4-6 hours to complete and may need to be repeated over multiple days to remove all excess fluid.

What to expect after therapeutic ultrafiltration

After the treatment, some patients feel like they may experience flu-like symptoms such as nausea, headaches, and/or overall discomfort due to the fluid removal process. These symptoms usually go away within 24 hours.

Who is a candidate for therapeutic ultrafiltration?

Therapeutic ultrafiltration is typically used in pediatric heart failure patients with severe fluid overload that can’t be managed with diuretics. Some specific conditions that might require this treatment include:

Congestive heart failure (CHF)

During CHF, the heart is unable to pump blood efficiently, leading to fluid buildup in the body.

Cardiomyopathies

These diseases of the heart muscle can cause heart failure and fluid overload.

Post-cardiopulmonary bypass surgery

After heart surgery, especially in complex congenital heart disease cases, fluid management is important to recovery.

Kidney diseases and/or failure

When kidney function is impaired, it can cause fluid retention, which can exacerbate fluid overload in patients with heart disease or failure.

These conditions often lead to symptoms like swelling, difficulty breathing, and fatigue, which can be alleviated by removing excess fluid through ultrafiltration.