Meta-analysis of Ultrafiltration versus Diuretics Treatment Option for Overload Volume Reduction in Patients with Acute Decompensated Heart Failure

Abstract

IntroductionAlthough diuretics are mainly used for the treatment of acute decompensated heart failure (ADHF), inadequate responses and complications have led to the use of extracorporeal ultrafiltration (UF) as an alternative strategy for reducing volume overloads in patients with ADHF.ObjectiveThe aim of our study is to perform meta-analysis of the results obtained from studies on extracorporeal venous ultrafiltration and compare them with those of standard diuretic treatment for overload volume reduction in acute decompensated heart failure.MethodsMEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials databases were systematically searched using a pre‑specified criterion. Pooled estimates of outcomes after 48 h (weight change, serum creatinine level, and all-cause mortality) were computed using random effect models. Pooled weighted mean differences were calculated for weight loss and change in creatinine level, whereas a pooled risk ratio was used for the analysis of binary all-cause mortality outcome.ResultsA total of nine studies, involving 613 patients, met the eligibility criteria. The mean weight loss in patients who underwent UF therapy was 1.78 kg [95% Confidence Interval (CI): −2.65 to −0.91 kg; p < 0.001) more than those who received standard diuretic therapy. The post-intervention creatinine level, however, was not significantly different (mean change = −0.25 mg/dL; 95% CI: −0.56 to 0.06 mg/dL; p = 0.112). The risk of all-cause mortality persisted in patients treated with UF compared with patients treated with standard diuretics (Pooled RR = 1.00; 95% CI: 0.64–1.56; p = 0.993).ConclusionCompared with standard diuretic therapy, UF treatment for overload volume reduction in individuals suffering from ADHF, resulted in significant reduction of body weight within 48 h. However, no significant decrease of serum creatinine level or reduction of all-cause mortality was observed.

Outcomes after Acute Peritoneal Dialysis for Critical Cardiorenal Syndrome Type 1

“…Fluid removal is one of the key methods for improving the outcome in CRS1. UF by extracorporeal therapy is commonly applied in CRS1 patients without renal impairment to those with mild renal insufficiency, but the benefit in mortality is still inconclusive [31]. By contrast, the role of PD in CRS1 is interesting due to good hemodynamic tolerability and more cost-effectiveness in some low- to middle-income regions [32].…”

KSHF Guidelines for the Management of Acute Heart Failure: Part II. Treatment of Acute Heart Failure

“…However, in a subsequent clinical study including patients with cardio-renal syndrome undergoing ultrafiltration versus medical treatment, ultrafiltration had negative effects in terms of renal dysfunction, persistent congestion symptoms, and renal function at 96 hours 50)51). A recent meta-analysis on the usefulness of ultrafiltration reported a beneficial effect on weight loss but no effect on creatinine reduction or mortality 52)…”