Study of Heart Failure Hospitalizations After Aquapheresis Therapy Compared to Intravenous (IV) Diuretic Treatment

Inclusion Criteria:

1. 18 years of age or older
2. Male or non-pregnant female patients
3. Admitted to the hospital with a primary diagnosis of acute decompensated heart failure (ADHF)
4. On regularly scheduled oral loop diuretics prior to admission
5. Fluid overload manifested by at least two of the following:
6. Pitting edema (2+) of the lower extremities
7. Jugular venous distention > 8 cm
8. Pulmonary edema or pleural effusion on chest x-ray
9. Paroxysmal nocturnal dyspnea or ≥ two- pillow orthopnea
10. Respiration rate ≥ 20 per minute.
11. Have received ≤ 2 IV loop diuretics doses before randomization
12. Must be able to be enrolled into the trial ≤ 24 hours of their admission to thehospital.
13. Provide written informed consent form as required by the local IRB (InstitutionalReview Board)

Exclusion Criteria:

1. Acute coronary syndromes
2. Renal insufficiency with a sCr ≥ 3.0 mg/dl or planned renal replacement therapies
3. Systolic blood pressure < 90 mmHg at time of enrollment
4. Pulmonary Arterial Hypertension not secondary to left heart disease
5. Contraindications to systemic anticoagulation
6. Hematocrit > 45%
7. Inability to obtain venous access
8. Hemodynamic instability severe enough to require IV positive inotropic agents, IVvasodilators or both
9. Use of iodinated radiocontrast material within the previous 72 hours or planned studyrequiring IV contrast during the current hospitalization
10. Severe concomitant disease expected to prolong hospitalization
11. Severe concomitant disease expected to cause death in ≤ 90 days
12. Sepsis or ongoing systemic infection
13. Severe uncorrected valvular stenosis
14. Active myocarditis
15. Hypertrophic obstructive cardiomyopathy
16. Constrictive pericarditis or restrictive cardiomyopathy
17. Liver cirrhosis
18. Previous solid organ transplant
19. Requirement for mechanical ventilatory support
20. Presence of a mechanical circulatory support device
21. Unwillingness or inability to complete follow up
22. Active drug or ETOH substance abuse
23. Participating in another interventional clinical trial