Please select the eligibility criteria that correspond to the clinical trial below.
Title: Impact of Different Therapeutic Approaches in Patients With Cardiorenal Syndrome in the Setting of Acute Decompensated Congestive Heart Failure (ADCHF)
Brief Summary: The purpose of this study is to determine whether in patients with acute decompensated congestive heart failure and the cardiorenal syndrome, i.e. a state in which therapy directed to improve symptoms is limited by further worsening renal function, fluid removal by ultrafiltration is superior to different pharmacological approaches in acutely relieving congestion and preventing further deterioration in renal function and whether it results in longer admission-free survival 90 days after enrolment


Options:
A: Inclusion Criteria:

* Patients over 18 years;
* Patients with diagnosis of ADHF(dyspnea, orthopnea, peripheral edema or major fatigue and at least two clinical signs including rales, hepatomegaly, pulmonary congestion on chest radiography, jugular vein dilatation, or a third heart sound);
* Blood BNP \> 100 pg/mL;

ADHF: Acute Decompensated Heart Failure; BNP: B-type Natriuretic Peptide; IV: IntraVenous; LVEF: Left Ventricular Ejection Fraction.

Exclusion Criteria:

* Patients who receive more than 40 mg of IV furosemide;
* End-Stage renal disease or renal replacement therapy;
* Recent myocardial infarction (within thirty days of screening);
* Systolic blood pressure \< 80 mmHg;
* Creatinine levels \> 4 mg/dL;
* Patients affected by sepsis, liver diseases, inflammatory diseases or neoplastic diseases.
B: Inclusion criteria

On admission (screening)

* Informed consent
* Age 18-80 years
* NYHA class III - IV
* Signs of pulmonary (pulmonary rales, and interstitial oedema or pleural effusion on chest Xray) and/or systemic congestion (pitting ankle oedema and enlarged liver or ascites and neck vein distension ≥ 7 cm) and weight gain ≥ 2 kg during the previous week
* Glomerular filtration rate ≥ 30 ml/min
* BNP increased \>400 pg/ml (diagnostic cut-off for ADCHF), as confirmatory diagnostic test)

  24 hours after admission (randomization)
* Persistent signs of pulmonary (pulmonary rales, interstitial oedema or pleural effusion on chest Xray) and/or systemic congestion (ankle oedema, enlarged liver or ascites, neck vein distension ≥ 7 cm)
* Serum creatinine or urine output criteria indicative of modified RIFLE (AKI: risk) class at least 1 (increase x 1.5 in serum creatinine or decrease \> 25% in GFR or urine output \< 0.5 ml/Kg/h for more than 6 hours) 29-30 during diuretic infusion

Exclusion criteria

* Chronic kidney disease stage 4-5 (GFR \< 30 ml/min)
* Acute coronary syndromes
* Systolic blood pressure \<90 mm Hg/need for intravenous inotropes
* Hematocrit \> 45%
* Unattainable venous access
* Contraindications to anticoagulation by heparin
* Systemic infection
* Heart transplant
C: Inclusion Criteria:

* Patients hospitalized with primary diagnosis of acute decompensated congestive heart failure (adCHF)
* Evidence of fluid overload as indicated by:

  1. pitting edema (2+) of lower extremities;
  2. jugular venous distension;
  3. pulmonary edema or pleural effusion;
  4. ascites;
  5. paroxysmal nocturnal dyspnea or 2-pillow orthopnea

Exclusion Criteria:

* Acute coronary syndrome
* Creatinine greater than 3.0
* Systolic blood pressure less than or equal to 90 mmHg
* Hematocrit greater than 45%
* Prior administration of IV vasoactive drugs in the emergency room (ER)
* Clinical instability requiring pressors during hospitalization
* Recent use of iodinated contrast material
* Severe concomitant disease expected to prolong hospitalization
* Sepsis
* On or requires renal dialysis
* Had a cardiac transplant
* Heparin allergy
D: Inclusion criteria:

* age 18 or older
* admitted to the hospital with a primary diagnosis of decompensated heart failure
* onset of cardiorenal syndrome after hospitalization or pre-hospitalization
* after hospitalization - onset of cardiorenal syndrome after hospitalization must occur within 10 days from the time of admission after receiving IV diuretics
* pre-hospitalization - onset of cardiorenal syndrome pre-hospitalization must occur within 12 weeks of the index hospitalization in the setting of escalating doses of outpatient diuretics
* persistent volume overload

Exclusion criteria:

* intravascular volume depletion based on investigator"s clinical assessment
* acute coronary syndrome within 4 weeks
* indication for hemodialysis
* creatinine \> 3.5 mg per deciliter at admission to the hospital
* systolic blood pressure \< 90 mmHg at the time of enrollment
* alternative 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 iodinated radio contrast material in the last 72 hours or anticipated use of IV contrast during the current hospitalization
* known bilateral renal artery stenosis
* active myocarditis
* hypertrophic obstructive cardiomyopathy
* severe valvular stenosis
* complex congenital heart disease
* sepsis or ongoing systemic infection
* enrollment in another clinical trial involving medical or device based interventions

Answer: B