Chronic renal disease (CKD) is known as a risk factor of cardiovascular disease. The patients who have progressed to severe renal failure such as CKD5D often develop heart failure like dilated cardiomyopathy (DCM), which leads a fall in blood pressure that occurs during a hemodialysis (HD) session, and finally is the major cause of the mortality of dialysis patients. Although pathogenesis and therapies of DCM have been discussed for a long time, both of the ultimate answers are still unknown. There have been reports that an antibody against β_1 adrenoceptors may be a pivotal factor that induces DCM. This has led to a possible new therapy, immunoadsorption (IA), which removes antibodies in order to induce early hemodynamic improvement in patients with DCM. However, the therapy of IA has not been accepted yet in Japan. Because double-filtration plasmapheresis (DFPP) has been used to eliminate macromolecules including immunoglobulins, we therefore investigated the efficacy of DFPP instead of IA for HD patients who suffered DCM. We first made screening tests of anti-β_1 adrenoceptor autoantibody in the serum of more than 120 patients undergoing HD. As a result, more than 20% of HD patients had that antibody. The patients who showed severe cardiac dysfunction without ischemic coronary disease were treated by DFPP twice a week. The DFPP procedure was performed as follows using KM-8600 (Kuraray, Japan). After heparinized blood was separated into blood cells and plasma by a plasma separator (PE-05), approximately 3 liters of the diseased plasma was filtered through a plasma fractionator (2A20). Several sessions of DFPP led to a rapid improvement of the clinical status with marked decreases in serum levels of anti-β_1 adrenoceptor autoantibody. The reduction in autoantibody levels was accompanied by an improvement of heart function. The severe adverse effects of DFPP were not observed. In conclusion, DFPP may be an effective and useful therapy for patients undergoing HD with severe heart failure due to DCM.