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Review
. 2021 May;26(3):577-585.
doi: 10.1007/s10741-020-10057-7. Epub 2020 Nov 26.

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

Bastian Wobbe  1 , Juliane Wagner  1 , Dorottya Kata Szabó  1 , Ildikó Rostás  2 , Nelli Farkas  2 , András Garami  2 , Márta Balaskó  2 , Petra Hartmann  3 , Margit Solymár  2 , Judit Tenk  2 , Máté Ottóffy  2 , Arnold Nagy  4 , Tamás Habon  1 , Péter Hegyi  2 , László Czopf  5   6
Affiliations
Review

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

Bastian Wobbe et al. Heart Fail Rev. 2021 May.

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.

Keywords: Acute heart failure; Diuretics; Meta-analysis; Ultrafiltration.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Flowchart of trial selection. Study selection flowchart according to PRISMA-P [12]
Fig. 2
Fig. 2
Assessment of risk of bias of included studies. Risk of bias summary according to the Cochrane Risk of Bias Tool for quality assessment of randomized controlled trials. Low risk of bias (plus-sign), unclear risk of bias (question mark) and high risk of bias (minus-sign). Short-term outcomes: fluid removal and weight loss. Long-term outcomes: adverse events, rehospitalization for heart failure (HF) and all-cause mortality
Fig. 3
Fig. 3
Forest plot of a fluid removal and b worsening heart failure a: Forest plot comparing the mean difference in fluid removal between the control and intervention groups. b: Forest plot comparing odds ratios of rehospitalization for heart failure. Squares represent odds ratios of rehospitalization for heart failure. Squares represent oddsratios of HF-related rehospitalization in the UF versus control group. The size of the square is proportional to the study weight. Error bars represent the 95% confidence interval. Diamonds represent pooled estimates for odds ratios with 95% CIs
Fig. 4
Fig. 4
Funnel plot for visualization of publication bias across studies for fluid removal a and all-cause mortality b
See this image and copyright information in PMC

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