Ultrafiltration by continuous venovenous hemofiltration (CVVH) is a well-established therapy for acute decompensated heart failure (ADHF). Aggressive fluid removal, however, may worsen the symptoms or even inflict de novo organ dysfunctions especially in the hemodynamically unstable patients. We described the incorporation of CVVH and impedance cardiography (ICG) in the management of an ADHF patient on maintenance hemodialysis. Simultaneous monitoring of the hemodynamic and fluid status using ICG helped optimize the CVVH prescription and improve the patient outcome. As such, assessment of the unique hemodynamic characteristics of each critically ill patient is indispensable, which may enhance the efficiency of the critical care unit. Selection of the ultrafiltration against diuretics is also discussed.