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Review
. 2019 Nov;24(6):927-940.
doi: 10.1007/s10741-019-09812-2.

Patients with high-dose diuretics should get ultrafiltration in the management of decompensated heart failure: a meta-analysis

Xiaofeng Shi  1 , Jiating Bao  2 , Haili Zhang  3 , Hao Wang  1 , Lei Li  4 , Yue Zhang  5
Affiliations
Review

Patients with high-dose diuretics should get ultrafiltration in the management of decompensated heart failure: a meta-analysis

Xiaofeng Shi et al. Heart Fail Rev. 2019 Nov.

Abstract

The identification of specific patients with decompensated heart failure (DHF) who may benefit from ultrafiltration (UF) is important in clinical practice. We undertook a meta-analysis to compare the effects of ultrafiltration and diuretics on major clinical outcomes. The outcomes included weight change, length of hospital stay, rehospitalization for HF, mortality, change in serum creatinine, dialysis dependence, and adverse outcomes. We identified 14 trials including 975 patients with HF, met the eligibility criteria. There was a reduction in heart failure-related rehospitalization in ultrafiltration group when compared with the diuretic group. Subgroup analyses revealed a trend toward the decreased HF readmissions in ultrafiltration plus diuretic therapy group but did not reach statistical significance compared with ultrafiltration alone therapy. Overall, UF treatment did not produce apparent beneficial effects for weight loss, lengths of hospitalization, total mortality, the change of serum creatinine, and dialysis rate. Subgroup analyses showed increase in the serum creatinine were significantly higher for a higher dose regimen (> 200 mg/day) when compared with lower dose diuretic therapy (< 200 mg/day). As for adverse events, UF patients were associated with an increased risk of hypotension and lower risk of neurologic symptoms. The current results revealed ultrafiltration was associated with significant reduction in the rate of rehospitalization. Increase in the serum creatinine was observed in patients with high-dose diuretic regimen. Patients with high-dose diuretics should get ultrafiltration therapy.

Keywords: Decompensated heart failure; Diuretics; Meta-analysis; Serum creatinine; Ultrafiltration.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Identification process for eligible studies
Fig. 2
Fig. 2
Pooled weight loss (kg) (a) and subgroup analysis of weight loss (b)
Fig. 3
Fig. 3
Pooled lengths of hospitalization (day) (a) and subgroup analysis of lengths of hospitalization (b)
Fig. 4
Fig. 4
Pooled rehospitalization for heart failure (a) and subgroup analysis of rehospitalization for heart failure (b)
Fig. 5
Fig. 5
Pooled total mortality (a) and subgroup analysis of mortality (b)
Fig. 6
Fig. 6
Pooled the change in serum creatinine (mg/dl) (a) and subgroup analysis of the change in serum creatinine (b)
Fig. 7
Fig. 7
Pooled dialysis dependence (a) and subgroup analysis of dialysis dependence (b)
See this image and copyright information in PMC

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References

    1. Fonarow GC, Adams KF, Jr, Abraham WT, et al. Risk stratification for in-hospital mortality in acutely decompensated heart failure: classification and regression tree analysis. Jama. 2005;293:572–580. doi: 10.1001/jama.293.5.572. - DOI - PubMed
    1. Krumholz HM, Parent EM, Tu N, Vaccarino V, Wang Y, Radford MJ, Hennen J. Readmission after hospitalization for congestive heart failure among Medicare beneficiaries. Arch Intern Med. 1997;157:99–104. doi: 10.1001/archinte.1997.00440220103013. - DOI - PubMed
    1. Felker GM, Lee KL, Bull DA, Redfield MM, Stevenson LW, Goldsmith SR, LeWinter M, Deswal A, Rouleau JL, Ofili EO, Anstrom KJ, Hernandez AF, McNulty S, Velazquez EJ, Kfoury AG, Chen HH, Givertz MM, Semigran MJ, Bart BA, Mascette AM, Braunwald E, O’Connor CM, NHLBI Heart Failure Clinical Research Network Diuretic strategies in patients with acute decompensated heart failure. N Engl J Med. 2011;364:797–805. doi: 10.1056/NEJMoa1005419. - DOI - PMC - PubMed
    1. Yayla C, Akyel A, Canpolat U, Gayretli Yayla K, Eyiol A, Akboğa MK, Türkoğlu S, Tavil Y, Boyacı B, Çengel A. Comparison of three diuretic treatment strategies for patients with acute decompensated heart failure. Herz. 2015;40:1115–1120. doi: 10.1007/s00059-015-4327-y. - DOI - PubMed
    1. Andrade JG, Stadnick E, Virani SA. The role of peripheral ultrafiltration in the management of acute decompensated heart failure. Blood Purif. 2010;29:177–182. doi: 10.1159/000245644. - DOI - PubMed

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