Table 2 - uploaded by Nader Makki
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Background: A number of small studies suggest that ultrafiltration (UF) can improve outcomes in patients with acute decompensated heart failure (ADHF), but substantial uncertainty remains. We conducted a systematic review and meta-analysis with the primary goal of assessing the impact of UF on all-cause mortality in adults with ADHF; the secondary...
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Citations
... thiazides, etc), implementation of fluid restriction, the aggressiveness of fluid restriction, use of continuous positive airway pressure, use of intravenous nitrates and use of inotropes. Furthermore, the timing of evaluation is important asthe amount of fluid loss, weight reduction and reduction in renal function after hospital stay or during follow up will depend on the aggressiveness of the usual care diuretic regime.A number of reviews have been previous published evaluating the efficacy of filtration compared to diuretic therapy.[16][17][18][19][20][21][22] Jain et al published the most recent review on ultrafiltration in acute heart failure.[22] ...
Background:
Ultrafiltration is a method used to achieve diuresis in acute decompensated heart failure (ADHF) when there is diuretic resistance, but its efficacy in other settings is unclear. We therefore conducted a systematic review and meta-analysis to evaluate the use of ultrafiltration in ADHF.
Methods:
We searched MEDLINE and EMBASE for studies that evaluated outcomes following filtration compared to diuretic therapy in ADHF. The outcomes of interest were body weight change, change in renal function, length of stay, frequency of rehospitalization, mortality and dependence on dialysis. We performed random effects meta-analyses to pool studies that evaluated the desired outcomes and assessed statistical heterogeneity using the I(2) statistic.
Results:
A total of 10 trials with 857 participants (mean age 68years, 71% male) compared filtration to usual diuretic care in ADHF. Nine studies evaluated weight change following filtration and the pooled results suggest a decline in mean body weight -1.8; 95% CI, -4.68 to 0.97 kg. Pooled results showed no difference between the filtration and diuretic group in change in creatinine or estimated glomerular filtration rate. The pooled results suggest longer hospital stay with filtration (mean difference, 3.70; 95% CI, -3.39 to 10.80days) and a reduction in heart failure hospitalization (RR, 0.71; 95% CI, 0.51-1.00) and all-cause rehospitalization (RR, 0.89; 95% CI, 0.43-1.86) compared to the diuretic group. Filtration was associated with a non-significant greater risk of death compared to diuretic use (RR, 1.08; 95% CI, 0.77-1.52).
Conclusions:
There is insufficient evidence supporting routine use of ultrafiltration in acute decompensated heart failure.
... Two independent systematic reviews and meta-analyses failed to show significant benefit in all-cause mortality or all-cause rehospitalization with ultrafiltration therapy compared to diuretic therapy. 54,55 In their meta-analysis of 12 studies involving 659 patients, Kwong et al. reported that ultrafiltration was associated with significantly greater fluid removal (mean difference, 1.28, 95% CI 0.43-2.12, P 5 0.003) and weight loss (mean difference 1.23, 95% CI 0.03 to 2.44, P 5 0.04) with follow-up duration ranging from 36 hours to 12 months. ...
... Makki and colleagues also questioned the generalizability of these studies. 55 Of 523 patients enrolled in their meta-analysis of 6 randomized controlled trials, 74.2% patients were male and 72.3% were Caucasian. ...
Chronic congestive heart failure (CHF) and acute decompensated heart failure (ADHF) refractory to medical therapy represent therapeutic challenges. In such patients, attempts to reduce pulmonary and systemic congestion frequently produce deterioration of renal function. In studies of patients with chronic severe CHF refractory to medical therapy (including loop diuretics), isolated ultrafiltration was frequently able to relieve congestive symptoms by precise removal of extracellular water and sodium, and in some cases was able to restore responsiveness to loop diuretics. Randomized controlled trials comparing isolated ultrafiltration and medical therapy (mainly loop diuretics) in patients with ADHF failed to demonstrate the superiority of isolated ultrafiltration over diuretic therapy with respect to renal function and mortality. Isolated ultrafiltration reduced length of hospital stay in several studies. At this time, there is insufficient evidence to support the use of isolated ultrafiltration as initial therapy of ADHF.
