A Meta-Analysis Of The Efficacy And Safety Of Renal Replacement Therapy In Refractory Heart Failure

Background:Current clinical guidelines recommend renal re-placement therapy as a treatment for patients with refractory heart failure,and many randomized controlled trials have been conducted in recent years,but the efficacy and safety of renal replacement therapy for refrac-tory heart failure remains unclear?Objective:Meta analysis was performed to evaluate the all-cause mortality,90-day readmission rate,cumulative readmission rate,volume reduction,length of stay,and serum creatinine level of renal replacement therapy in patients with refractory heart failure to evaluate the efficacy and safety,providing a strong basis for future clinical treatment options.Methods:By reviewing PubMed,EMBASE,Cocharne Library,WanFang,Cnki,China biomedical literature database and other databases in both Chinese and English,all published randomized controlled clinical trials of renal replacement therapy for refractory heart failure were col-lected,and the search time was up to September 2019.According to the inclusion criteria and exclusion criteria,the two evaluators independently screened the literature and extracted the data,evaluated the quality of the included literature,and used Review Manager5.3 for Meta analysis.Results:Compared with the drug treatment group,the cumulative readability rate of the renal replacement group was(RR=0.71,CI=[0.49,1.02],p=0.07,I~2=47%).Rate of readmission at 90 days:(RR=0.65,CI=[0.47,0.90],p=0.01,I~2=0%);All-cause readmission rate:(RR=0.65,CI=[0.11,3.72],p=0.63),I~2=87%);Mortality:(RR=0.01,CI=[-0.04,0.06],p=0.67,I~2=0%).Cumulative length of hospitalization:(RR=0.23,CI=[-1.03,1.48],p=0.72,I~2=77%);Body mass reduction:(WMD:1.06kg,95%CI=[-1.55,-0.57],p<0.0001,I~2=67%);Serum creatinine level(SMD:0.11mg/dl;95%CI=[-0.01,0.23],p=0.07;I~2=35%).Conclusion:Compared with diuretics therapy,renal replacement therapy can significantly reduce the readmission rate of heart failure pa-tients within 90 days.There may be a certain relationship in reducing the cumulative readmission rate;No evidence shows that renal replacement therapy reduces mortality;Renal replacement therapy can reduce the body mass of patients more effectively,but the difference in the effect of the two treatments on the serum creatinine level is not obvious.Due to the limitations of the quantity and quality of the included studies,we con-clude that more large sample,high-quality randomized controlled clinical trials are needed to further explore the application of renal replacement therapy in refractory heart failure.