Key result
Early ultrafiltration increases ADHF weight loss ~45% but raises creatinine without reducing rehospitalization or mortality.
Why the study?
The study was conducted to investigate the efficacy and safety of early ultrafiltration in patients with acute decompensated heart failure.
Does early ultrafiltration improve body weight, renal function, readmission, and mortality in patients with acute decompensated heart failure compared to conventional diuretics?
Meta-Analysis (n=850)
Does early ultrafiltration improve body weight, renal function, readmission, and mortality in patients with acute decompensated heart failure compared to conventional diuretics?
Early ultrafiltration in acute decompensated heart failure effectively reduces body weight but increases serum creatinine without improving 30-day readmission or mortality compared to conventional diuretics.
Early ultrafiltration reduces weight but raises creatinine without cutting rehospitalization or mortality; challenges routine use over diuretics in acute decompensated heart failure.
Objective The objective of this study is to investigate the efficacy and safety of early ultrafiltration in patients with acute decompensated heart failure. Methods A systematic search was conducted on PubMed, Cochrane Library, and EMbase databases from inception to April 2023 to identify randomized controlled trials that compared the efficacy and safety of early ultrafiltration and conventional diuretics in patients with acute decompensated heart failure. Two investigators independently screened all eligible studies and extracted relevant data. The primary outcomes of interest were changes in body weight and creatinine levels, as well as the rate of readmission and mortality within 30 days. Meta-analysis was conducted using RevMan 5.4 software. Results This meta-analysis included eight studies and found that early ultrafiltration was effective in reducing body weight in patients with acute decompensated heart failure ( RR = 1.45, 95% CI: 0.54–2.35, P = 0.002), but it also increased serum creatinine ( RR = 0.1, 95% CI: 0.03–0.17, P = 0.003). However, it did not reduce the 30-day rehospitalization rate or mortality rate (30-day rehospitalization rate: RR = 0.84, 95% CI: 0.62–1.14, P = 0.28; Mortality: RR = 0.90, 95% CI: 0.57–1.44, P = 0.67). Conclusion Although early ultrafiltration is more effective in reducing body weight in patients with acute decompensated heart failure, it is associated with an increase in serum creatinine levels and does not reduce the rate of readmission or mortality within 30 days. Systematic Review Registration identifier: CRD42023416152.
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Chen et al. (2023) conducted a meta-analysis in acute decompensated heart failure (n=850). Early ultrafiltration vs. Conventional diuretics was evaluated on Changes in body weight (RR 1.45, 95% CI 0.54-2.35, p=0.002). Early ultrafiltration effectively reduced body weight (RR 1.45) in patients with acute decompensated heart failure, but increased serum creatinine without reducing 30-day rehospitalization or mortality.
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