What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Acute decompensated heart failure (ADHF) (n=801). Intervention: Ultrafiltration vs. Usual care (diuretic therapy). Primary outcome: Fluid removal (Difference in means 1372.5 mL, 95% CI 849.6 to 1895.4, p=<0.001).

November 26, 2020Open Access

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

Q: What are the key findings of this study?

Ultrafiltration significantly increased fluid removal (difference in means 1372.5 mL) and reduced heart failure rehospitalization (OR 0.54) compared to diuretic therapy in acute heart failure.

BWBastian WobbeKlinikum Oldenburg JWJuliane WagnerUniversity Hospital Schleswig-Holstein DSDorottya SzabóUniversity of Pecs

Key Result

Ultrafiltration significantly increased fluid removal (difference in means 1372.5 mL) and reduced heart failure rehospitalization (OR 0.54) compared to diuretic therapy in acute heart failure.

Study Design

Type

Meta-Analysis (n=801)

Structured PICO

Does ultrafiltration improve fluid removal and reduce rehospitalization compared to usual diuretic therapy in patients with acute decompensated heart failure?

Population

801 adults diagnosed with acute decompensated heart failure (ADHF) presenting with signs and symptoms of congestion, pooled from 8 randomized controlled trials.

Intervention

Ultrafiltration (UF) at a rate of 100 to 500 mL/h using devices such as Aquadex System 100, NxStage System One, or PRISMA System.

Comparator

Usual care treatment using diuretic agents (loop diuretics, e.g., furosemide up to 1446 mg/day).

Outcome

Amount of fluid removal (mL), number of patients rehospitalized for heart failure during follow-up, and incidences of adverse events (worsening heart failure and renal impairment).

Ultrafiltration is a safe and effective alternative to diuretic therapy in volume-overloaded acute heart failure, significantly increasing fluid removal and reducing heart failure rehospitalizations without worsening renal function.

Main Result

Effect estimate: Difference in means 1372.5 mL (95% CI 849.6 to 1895.4)

p-value: p=<0.001

Limitations

Considerable differences in the intervention protocols (UF rate, diuretic dosage, etc.) and time of measurement across the included studies
Possible risks of bias within the studies, particularly industry funding
Evidence of heterogeneity for certain outcomes, which might be explained by the small number of studies
Different search terms were used to identify suitable studies during the selection process

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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