Ultrafiltration In Patients With Acute Decompensated Heart Failure: A Meta-analysis

Objective: To evaluate the effectiveness of ultrafiltration in acute decompensated heart failure(ADHF), so as to provide high quality evidence for formulating the rational ADHF therapy. Methods: Databases including PubMed, EMBASE, Wan Fang, CNKI and CBM were searched to collect randomized controlled trial(RCT) on ultrafiltration in ADHF published before December 2015. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and evaluated the methodological quality of the included studies. Then the meta-analysis was conducted using RevMan5.3 software. Results: A total of 14 trials involving 755 patients were included. There were 376 patients in ultrafiltration group,and 379 patients in the control group. The results of meta-analysis showed that ultrafiltration therapy was not associated with significantly decreased risk of all-cause mortality(RR=0.95, 95% CI 0.65 to 1.38, P=0.77), rehospitalization(RR=0.78, 95% CI 0.49 to 1.24, P=0.29) and change in serum creatinine(WMD=0.02mg/dL, 95% CI-0.18 to 0.21, P=0.87). However, there was significantly more weight loss(WMD=1.32 kg, 95%CI 0.29 to 2.35, P=0.01) and net fluid removal(WMD=1.27 kg, 95%CI 0.43 to 2.12, P=0.003) in the ultrafiltration therapy group. Conclusion: Current evidence shows that for patients with ADHF, ultrafiltration is effective in reducing fluid retention, with no significant benefits in renal function preservation, mortality and rehospitalization. Due to the limited quality and quantity of the included studies, this conclusion still needs to be further proved by performing more large-scale and high quality RCTs, so we suggest clinician should adopt rational therapies based on patient’s conditions.