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

Wobbe, Bastian and Wagner, Juliane and Szabó, Dorottya Kata and Rostás, Ildikó and Farkas, Nelli and Garami, András and Balaskó, Márta and Hartmann, Petra and Solymár, Margit and Tenk, Judit and Ottóffy, Máté and Nagy, Arnold and Habon, Tamás and Hegyi, Péter and Czopf, László (2021) Ultrafiltration is better than diuretic therapy for volume-overloaded acute heart failure patients: a meta-analysis. HEART FAILURE REVIEWS, 26. pp. 577-585. ISSN 1382-4147 (print); 1573-7322 (online)

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Abstract

Studies on the effectiveness of ultrafiltration (UF) in patients hospitalized with acute decompensated heart failure (ADHF) have led to heterogeneous study outcomes. This meta-analysis aimed to assess the impact of UF therapy in ADHF patients. We searched the medical literature to identify well-designed studies comparing UF with the usual diuretic therapy in this setting. Systematic evaluation of 8 randomized controlled trials enrolling 801 participants showed greater fluid removal (difference in means 1372.5 mL, 95% CI 849.6 to 1895.4 mL; p < 0.001), weight loss (difference in means 1.592 kg, 95% CI 1.039 to 2.144 kg; p < 0.001) and lower incidences of worsening heart failure (OR 0.63, 95% CI 0.43 to 0.94, p = 0.022) and rehospitalization for heart failure (OR 0.54, 95% CI 0.36 to 0.82, p = 0.003) without a difference in renal impairment (OR 1.386, 95% CI 0.870 to 2.209; p = 0.169) or all-cause mortality (OR 1.13, 95% CI 0.75 to 1.71, p = 0.546). UF increases fluid removal and weight loss and reduces rehospitalization and the risk of worsening heart failure in congestive patients, suggesting ultrafiltration as a safe and effective treatment option for volume-overloaded heart failure patients.

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