Ultrafiltration (UF) is currently one of the most expensive therapeutic modalities used for the management of heart failure, and cost has become an impediment to its wider use. Providers and facilities are faced with balancing the price of the UF supplies with the financial reimbursement (i.e., diagnosis-related group payment) and potential savings from reduced length of hospital stay or readmissions. We as nephrologists write now to heighten awareness that there is a remarkably wide range of costs for various brands of equipment and disposables: choices that must be fully explored in deciding whether (or how) to launch new UF programs in a particular facility. For example, in the first published cost analysis study in this field, despite a reduced readmission rate in the Ultrafiltration Versus Intravenous Diuretics for Patients Hospitalized for Acute Decompensated Heart Failure (UNLOAD) trial, Bradley et al concluded that UF is unlikely to result in any cost savings. Those calculations, however, were based on the use of a recently developed compact device using proprietary supplies. Thus, not surprisingly, hemofilters constituted 82.5% of the UF costs ($2,191 of $2,656) and represented the most expensive item among the 5 factors that were analyzed. We have previously suggested that it would be financially more advantageous to use already existing resources such as nursing staff and disposable supplies to deliver extracorporeal therapy for patients with heart failure. The cost of the extracorporeal disposable circuit in renal replacement therapy devices is in the range of 2% to 20% of that used for the dedicated UF machine. Furthermore, in the UNLOAD trial, a mean of 2.4 hemofilters were used for each session, with a mean duration of 12.3 hours. In our experience, the far less expensive hemofilters for hemodialysis or continuous renal replacement therapy can last >50 hours. Therefore, if conventional devices and filters are used for UF therapy in patients with heart failure, the cost of treatment will dramatically decrease, and it would be likely for this modality to become financially comparable or even advantageous in the long term. If the cost of the hemofilters in Bradley et al’s study is recalculated using conventional cheaper supplies, the results of the decision model analysis would indeed become in favor of UF (i.e., patient component costs at 90-day follow-up from a societal perspective $11,293 for UF vs $11,610 for diuretics). We thus implore manufacturers and clinicians to devise UF strategies using existing low-cost technology to allow these programs to be financially viable.