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

Wobbe, Bastian; Wagner, Juliane; Szabó, Dorottya; Rostás, Ildikó; Farkas, Nelli; Garami, András; Balaskó, Márta; Hartmann, Petra; Solymár, Margit; Tenk, Judit; Ottóffy, Máté; Nagy, Arnold; Habon, Tamás; Hegyi, Péter; Czopf, László

doi:10.1007/s10741-020-10057-7

Cited by 17 publications

(15 citation statements)

References 28 publications

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“…Our results were partly consistent with Wobbe meta-analysis. [ 20 ] Moreover, we updated the review by adding 4 more studies, and heterogeneity was lower in our analysis. Heterogeneity still existed in weight loss regardless of sensitivity analysis, but not in fluid loss.…”

Section: Discussionmentioning

confidence: 99%

“…A meta-analysis of Wobbe et al [ 20 ] suggested that UF is a safe and effective treatment without a difference in renal impairment, and lower incidences of worsening heart failure. Shi et al [ 21 ] concluded that UF did not have a difference in worsening heart failure, cardiovascular outcome, hemorrhage, the change of serum creatinine and infection, but not in hypotension.…”

Section: Discussionmentioning

confidence: 99%

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Ultrafiltration for patients with acute decompensated heart failure

Wang

Zheng²,

Jin³

2021

Medicine

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Background: Ultrafiltration plays an indispensable role in relieving congestion and fluid retention in patients with acute decompensated heart failure (ADHF) in recent years. So far, there is no consistent agreement about whether early ultrafiltration (UF) is a first-line treatment for patients with ADHF. We, therefore, conducted a meta-analysis to assess the efficacy and safety of UF. Methods: PubMed, Embase, and Cochrane Library databases were searched for randomized controlled trials (RCTs) that compared UF with diuretics in patients with ADHF and included our interested outcomes. The primary outcomes are heart failure rehospitalization, all-cause rehospitalization, and mortality. The second outcomes are fluid loss, weight loss, and adverse events. RevMan Version 5.4.1 was used to analyze the data of included studies. Results: A total of 12 studies with 1197 patients were included. Our results showed a reduction in heart failure rehospitalization (risk ratio [RR] 0.67, 95% confidence interval [CI]: 0.52–0.87, P = .003) and all-cause rehospitalization (RR 0.62, 95% CI: 0.42–0.92; P = .02), an increase in fluid loss (1.47 L, 95% CI: 0.95–1.99 L, P < .001) and weight loss (1.65 kg, 95% CI: 0.90–2.41 kg; P < .001). There was no difference in mortality (RR 1.09, 95% CI: 0.78–1.51; P = .62). There were inconsistent agreements about which group have more total adverse events. Subgroup analysis showed that UF with larger mean fluid-remove rate (≥200 mL/h) could significantly remove more fluid, lose more weight, and decrease heart failure rehospitalization. Less weight loss for patients with ADHF may correlated to higher percent of ischemic etiology (ischemic etiology ≥50%). Conclusion: Although UF is more effective in removing fluid than diuretics and decrease rehospitalization of heart failure and all causes, there is not enough evidence to prove that UF is superior because of adverse events and mortality in the UF group. The mean fluid-removal rates should be set to ≥200 mL/h. Patient with different etiology may have different effects when treated with UF and it is a weak conclusion. Trial registration: The systematic review was registered with the International Prospective Registry of Systematic Reviews. ( https://www.crd.york.ac.uk/prospero/ , registration number CRD42021245049).

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Ultrafiltration for patients with acute decompensated heart failure

Wang

Zheng²,

Jin³

2021

Medicine

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“…The results showed greater fluid removal and weight loss, and lower incidence of worsening HF and rehospitalizations for HF, without effects on renal function and all-cause mortality. 40 Regrettably, neither of these studies evaluated the incidence of adverse effects, such as catheter related infections, filter clotting, etc.…”

Section: Clinical Trials Comparing Uf and Diuretic Treatmentmentioning

confidence: 99%

Ultrafiltration in acute heart failure: Current knowledge and fields for further research

Urban¹,

Błaziak²,

Biegus³

et al. 2021

Adv Clin Exp Med

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Heart failure is one of the leading causes of death in developed countries and remains a significant burden to the healthcare system. Fluid overload is a process responsible for the majority of the heart failure symptoms. Pharmacotherapy is a first-line treatment for this condition; however, due to the phenomenon of diuretic resistance, drug therapy can frequently be insufficient. Ultrafiltration is a promising but still understudied procedure that effectively targets the underlying pathophysiological mechanisms of congestion. The increased availability of simplified ultrafiltration devices, especially in intensive care units, prompted us to perform a current literature review on this treatment. In the present paper, we provide a concise review of the published trials on ultrafiltration, with a brief commentary on their conclusions and shortcomings. We also discuss the practical aspects of this treatment that remain unclear, such as the accurate selection of patients, choosing a suitable protocol for ultrafiltration, the proper time of initiation, monitoring of the therapy, and its desirable effects on renal function with further restoration of diuretic agent responsiveness.

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“…64 UF is better than diuretics regarding fluid removal rate and weight loss and reduces rehospitalization rate. 65 So, UF improves quality of life decrease morbidity but have no impact upon mortality. 65 Nevertheless, several studies are not benefiting from UF.…”

Section: Introduction: Pathophysiology and Rationale Of Ultrafiltrationmentioning

confidence: 99%

“…65 So, UF improves quality of life decrease morbidity but have no impact upon mortality. 65 Nevertheless, several studies are not benefiting from UF. For instance, background UF is not commonly used because of higher incidence of worsening renal function without improved decongestion.…”

Section: Introduction: Pathophysiology and Rationale Of Ultrafiltrationmentioning

confidence: 99%

Continuous renal replacement therapy under special conditions like sepsis, burn, cardiac failure, neurotrauma, and liver failure

Davenport

Honoré

2021

Seminars in Dialysis

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Continuous renal replacement therapy (CRRT) in sepsis does have a role in removing excessive fluid, and also role in removal of mediators although not proven today, and to allow fluid space in order to feed. In these conditions, continuous renal replacement therapy can improve morbidity but never mortality so far. Regarding sepsis, timing has become a more important issue after decades and is currently more discussed than dosing. Rationale of blood purification has evolved a lot in the last years regarding sepsis with the discovery of many types of sorbent allowing ideas from science fiction to become reality in 2021. Undoubtedly, COVID-19 has reactivated the interest of blood purification in sepsis but also in COVID-19. Burn is even more dependent about removal of excessive fluid as compared to sepsis. Regarding cardiac failure, ultrafiltration can improve the quality of life and morbidity when diuretics are becoming inefficient but can never improve mortality. Regarding brain injury, CRRTs have several advantages as compared to intermittent hemodialysis. In liver failure, there have been no randomized controlled trials to examine whether single-pass albumin dialysis offers advantages over standard supportive care, and there is always the cost of albumin.

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

Cited by 17 publications

References 28 publications

Ultrafiltration for patients with acute decompensated heart failure

Ultrafiltration for patients with acute decompensated heart failure

Ultrafiltration in acute heart failure: Current knowledge and fields for further research

Continuous renal replacement therapy under special conditions like sepsis, burn, cardiac failure, neurotrauma, and liver failure

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