Effectiveness of ultrafiltration in the treatment of acute decompensated heart failure: A meta-analysis of randomized controlled trials.

BACKGROUND: Acute decompensated heart failure (ADHF) is defined as the new onset or recurrence of gradually or rapidly developing symptoms and signs of heart failure requiring urgent or emergent therapy and resulting in hospitalization. Ultrafiltration emerges as a promising alternative to diuretics in patients with signs and symptoms of volume overload. It allows extracorporeal removal of plasma from the whole blood across a semi-permeable membrane through a transmembrane pressure gradient. The objective of this meta-analysis is to compare  the benefit of ultrafiltration vs intravenous loop diuretics in patients with ADHF.

METHODS: This was a meta-analysis of randomized controlled trials that compared the effectiveness of ultrafltration vs intravenous loop diuretics in reducing systemic congestion among ADHF patients. Articles were identified through PubMed, Medline, Cochrane and internet electronic databases. Two reviewers independently assessed and abstracted data from the included studies using the Quality Scale for Meta-analytic Review Form and Data Extraction Form randomized controlled trials. Analyses were performed using RevMan 5.2.

RESULTS: Ultrafiltration was superior to intravenous loop diuretics in terms of mean change in weight from baseline (WMD -1.78 kg; 95%CI -2.40 to -1.17; p<0.00001). The test for heterogeneity was not significant (chi-square=1.08; p=0.58; I²=58%) after doing a sensitivity analysis. The outcomes on mean change in re-hospitalization and mortality were similar between the two arms. The outcome of change in creatinine clearance was inconclusive.