The epithet of acute decompensated heart failure (ADHF) is volume overload. ADHF is associated with a rising number of hospital admission for volume overload. Medication non-compliance, excessive salt intake, comorbidities, and/or disease progression can attribute to volume overload. Heart failure (HF) therapy has innovated during the past few decades, but diuretics have been the mainstay of treatment. Diuretics are vital even though these drugs stimulate the renin-angiotensin-aldosterone system (RAAS) and lead to adaptive responses like diuretic resistance, neurohormonal activation, and worsening renal function that may be inimical. There has been a thriving interest in cutting-edge strategies to manage volume overload in ADHF. The American College of Cardiology Foundation (ACCF) and the American Heart Association (AHA) guidelines advocate pharmacological and non-pharmacological interventions to treat volume overload in ADHF patients. Ultrafiltration (UF) is, therefore, an emerging stand-in therapy of interest for treating volume overload in ADHF patients. This review article epitomizes available clinical data on the use of diuretics and UF in ADHF patients and identifies challenges for each approach.Copyright © 2020, Zafar et al.