Efficacy And Safety Of Ultrafiltration Versus Intravenous Diuretics In Patients With Acute Decompensated Heart Failure: A Meta-analysis Of Randomised Controlled Trials

Objective Acute decompensated heart failure (ADHF) represents a life-threatening and costly disease. A controversy remains regarding the efficacyand safety of ultrafiltration(UF) versus intravenous diuretics(ID) fortreatment of ADHF. We therefore performed this meta-analysis ofrandomised controlled trials (RCTs) to evaluate this clinical issue.Method The PubMed, EMBASE and the Cochrane Controlled TrialsRegister databases were searched from inception to April2014for relevantrandomised controlled trials. The Jadad scale was used toassess the qualityof the included studies. Data concerning the study design, patientcharacteristics, therapy and outcomes were extracted. The risk ratio (RR)and weighted mean differences (WMD)/standardi-sed mean differences(SMD) were calculated and pooled using fixed or random effects models.Results This meta-analysis included six randomized controlled trials with atotal of513patients. Ultrafiltration was superior to intra-venous diuretic therapy in weight loss (WMD:1.70kg; P=0.006) and total fluid loss (WMD:1.23L; P<0.0001). However, no significant effects were demonstrated onthe serum creatinine level, glomerular filtration rate (GFR), serumNT-proBNP level, rehospitalisation for heart failure (HF) and all-causemortality.Conclusion The use of ultrafiltration in ADHF patients is superior tointravenous diuretic therapy with respect to the volume management ofweight loss and total fluid output, indicating short-term remission ofcongestive symptoms. Nevertheless, it failed to improve the long-termprognosis. Moreover, the strategy of ultrafiltration does not exert adverserenal effects, demonstrating that it is an efficient and safe approach todecongestion in ADHF patients.