Comparison of Ultrafiltration and Intravenous Diuretic Therapies in Patients Hospitalized for Acute Decompensated Biventricular Heart Failure

Abstract

OBJECTIVE: Studies comparing ultrafiltration and diuretics in management of ADHF have shown controversial results. In this study, we compared the efficacy and safety of intravenous diuretic therapy and ultrafiltration in patients admitted with acute decompensated heart failure (ADHF) who had right ventricular dysfunction superimposed on left ventricular systolic dysfunction. MATERIAL and METHODs:A total of 30 patients of whom 10 were in the ultrafiltration group and 20 were in the diuretic group were enrolled in this study and followed for 3 months.REsULTs: At discharge, there were no significant differences between the ultrafiltration and diuretic groups in terms of weight loss , total fluid loss, and changes in serum creatinine. The clinical decongestion rates were similar in the two groups. Moreover, echocardiographic and biochemical parameters and alterations in renin and aldosterone levels, as measured to assess neurohormonal activation, had overlapping results between the two groups. When unwanted events were analyzed, transition to hemodialysis was seen in 20% of the patients in the ultrafiltration group and 5% of the patients in the diuretic group. The frequency of cardiac arrest and death were 40% in the ultrafiltration group and 10% in the diuretic group. Weight change, creatinine, and electrolyte levels of the patients at 1 and 3 months were also similar. CONCLUsION:Despite the high frequency of hemodialysis transition, cardiac arrest, and death in the ultrafiltration group, safety of ultrafiltration could not be assessed because of inability to perform statistical analyses. Further studies are needed to investigate the practical uses of ultrafiltration in routine clinical practice.

Ultrafiltration is better than diuretic therapy for volume-overloaded acute heart failure patients: a meta-analysis

“…1). [7,[9][10][11][16][17][18][19]. Table 1 shows the characteristics of the studies that were included in this meta-analysis, while the outcomes of the included studies are shown in Table 2.…”

“…Seven studies enrolling 745 patients provided data on the extent of fluid removal [ 7 , 9 – 11 , 17 , 18 ]. Treatment with ultrafiltration led to a significantly larger net volume of fluid removal compared to usual care (difference in means: 1372.5 mL, 95% CI 849.6 to 1895.4 mL; p < 0.001, I 2 = 48.41%) (Fig.…”

“…The incidence of renal impairment was reported in 5 studies, enrolling 675 patients in total [7,9,11,17,18]. A total of 331 patients were randomized to the UF group, while 344 received usual care treatment.…”

“…A number of small RCTs have investigated the influence of UF treatment compared to usual care therapy so far, but the results remain heterogeneous [9][10][11].…”

Ultrafiltration for acute decompensated cardiac failure: A systematic review and meta-analysis

“…After independent screening for study inclusion, the full manuscripts or conference abstracts of 57 studies were reviewed and 10 were retained for final inclusion in the review. [3][4][5][6][8][9][10][11][12][13][14][15] A C C E P T E D M A N U S C R I P T…”