Ultrafiltration reduced the risk of clinical worsening (OR 0.57; 95% CI 0.38-0.86; P=0.007) and increased clinical decongestion compared to loop diuretics in acute decompensated heart failure.
Meta-Analysis
Does ultrafiltration improve clinical outcomes compared to intravenous loop diuretics in patients with acute decompensated heart failure?
In patients with acute decompensated heart failure, ultrafiltration improves decongestion and reduces clinical worsening compared to intravenous loop diuretics, but does not impact re-hospitalization or mortality.
Odds Ratio: 0.57 (95% CI 0.38–0.86)
p-value: p=0.007
Background Intravenous loop diuretics are the first-line therapy for acute decompensated heart failure (ADHF) but many patients are discharged with unresolved congestion resulting in higher re-hospitalization and mortality rates. Ultrafiltration (UF) is a promising intervention for ADHF. However, studies comparing UF to diuretics have been inconsistent in their clinical outcomes. Methods A comprehensive literature search was performed. Trials were included if they met the following criteria: (1) randomization with a control group, (2) comparison of UF with a loop diuretic, and (3) a diagnosis of ADHF. Results When compared to diuretics, UF was associated with a reduced risk of clinical worsening (odds ratio (OR) 0.57, 95% CI: 0.38-0.86, P-value 0.007), increased likelihood for clinical decongestion (OR 2.32, 95% CI: 1.09-4.91, P-value 0.03) with greater weight (0.97 Kg, 95% CI: 0.52-1.42, P-value <0.0001) and volume reduction (1.11 L, 95% CI: 0.68-1.54, P-value <0.0001). The overall risk of re-hospitalization (OR 0.92, 95% CI: 0.62-1.38, P-value 0.70), return to emergency department (OR 0.69, 95% CI: 0.44-1.08, P-value 0.10) and mortality (OR 0.99, 95% CI: 0.60-1.62, P-value 0.97) were not significantly improved by UF treatment. Conclusions UF is associated with significant improvements in clinical decongestion but not in rates of re-hospitalization or mortality.
Kabach et al. (Tue,) conducted a meta-analysis in acute decompensated heart failure. Ultrafiltration vs. Intravenous loop diuretics was evaluated on clinical worsening (OR 0.57, 95% CI 0.38-0.86, p=0.007). Ultrafiltration reduced the risk of clinical worsening (OR 0.57; 95% CI 0.38-0.86; P=0.007) and increased clinical decongestion compared to loop diuretics in acute decompensated heart failure.
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