Key result
Ultrafiltration cuts 30-day readmissions ~45% vs. conventional diuretics in decompensated heart failure.
Why the study?
When response to high doses of diuretics is poor in cardiorenal syndrome with systemic congestion, ultrafiltration appears to be useful and safe, prompting an evaluation of its efficacy and safety versus conventional diuretic treatment.
Does ultrafiltration improve renal function, diuretic response, and morbimortality compared to conventional diuretic treatment in patients with decompensated heart failure and cardiorenal syndrome?
Systematic Review (n=1,100)
Does ultrafiltration improve renal function, diuretic response, and morbimortality compared to conventional diuretic treatment in patients with decompensated heart failure and cardiorenal syndrome?
Odds Ratio: 0.55 (95% CI 0.39–0.77)
In patients with decompensated heart failure and cardiorenal syndrome, ultrafiltration reduces hospital readmissions and tends to improve decongestion and creatinine levels compared to diuretic therapy, without affecting short-term mortality.
Supports ultrafiltration to reduce 30-day readmissions in decompensated HF; extends evidence versus diuretics in cardiorenal syndrome.
Aims Cardiac decompensation in cardiorenal syndrome (CRS) results in systemic congestion usually treated with diuretics. When despite high doses of diuretics, response is poor, ultrafiltration (UF) appears to be a useful and safe technique. The aim of the study was to analyse, by means of a systematic review, the efficacy and safety of UF versus conventional diuretic treatment. Methods and results Search of the main databases (Pubmed, Embase and Cochrane Central Register of Controlled Trials) identifying comparative studies of UF versus diuretic therapy, from 2000 to the present. After screening the studies, 13 studies were analysed; 1100 patients (UF: 532, diuretic treatment: 568). Renal function: UF showed a trend to lower creatinine at discharge (SME = −0.68; 95% CI −1.50 to 0.13; I2 = 97%) with no difference in glomerular filtration rate (SME = 0.05; 95% CI −0.17 to 0.27; I2 = 0%). Diuretic response: With UF, there was a trend towards greater weight loss (SME = 1.82; 95% CI −0.79 to 4.42; I2 = 99.7%) and greater volume removed (SME = 3.04; 95% CI −2.13 to 8.20; I2 = 99.8%). Morbidity and mortality: No difference in days of hospital stay (LogOR = −0.14; 95% CI −0.52 to 0.23; I2 = 66.9%) and mortality at 1 month (LogOR = −0.04; 95% CI −0.34 to 0.44; I2 = 0%) but reduction in readmissions in patients with UF (LogOR = −0.60; 95% CI −0.94 to −0.26; I2 = 40.5%). Conclusions In decompensated HF and CRS with inadequate diuretic response, UF versus diuretic intensification is an effective and safe option; it reduces readmissions with a tendency to decrease weight, creatinine levels and increase volume depletion without affecting mortality. Prospective randomised studies with a sufficient number of patients are needed to corroborate these results.
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Cervera et al. (2024) conducted a systematic review in Decompensated heart failure and cardiorenal syndrome (n=1,100). Ultrafiltration vs. Conventional diuretic treatment was evaluated on Readmissions in the first month (OR 0.55, 95% CI 0.39 to 0.77). Ultrafiltration significantly reduced hospital readmissions in the first month compared to conventional diuretic therapy in patients with decompensated heart failure (OR 0.55).
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