Abstract 10878: Ultrafiltration or Intravenous Diuretics in Patients With Acute Decompensated Heart Failure: A Meta-analysis of Randomized Clinical Trials
Introduction: Intravenous diuretics (IVD) are the main stem treatment of acute decompensated heart failure (ADHF). Due to the significant rate of complications and inadequate response in severe cases, extracorporeal ultrafiltration (UF) has been proposed as an alternative treatment to reduce volume overload in those cases. We have conducted a meta-analysis of studies comparing IVD with UF for the treatment of ADHF.
Methods: Medline, EMBASE, and the Cochrane Central Register of Controlled Trials databases were systematically searched using a pre-specified criterion. Pooled estimates for the outcomes of weight change, change in creatinine and risk of all-cause mortality were computed using random effect models. Pooled weighted mean differences were calculated for weight loss and change in creatinine and a pooled risk ratio (RR) for the outcome of mortality.
Results: Nine studies were included in this analysis (613 patients). The 48-hour weight loss among patients who underwent UF was 1.05 kg (95% Confidence Interval [CI] -2.21, 0.11kg; p=0.075) higher than it was among patients who received standard diuretic therapy. In addition, post-intervention reduction in creatinine was 0.25mg/dL (95% CI -0.56, 0.06mg/dL, p=0.112) higher for patients who underwent UF therapy. However, there mortality risk was similar in both groups. (Pooled RR=1.00, 95% CI 0.64, 1.56, p=0.993).
Conclusion: Compared to standard intravenous diuretic therapy, the use of UF to treat the volume overload state in patients with ADHF did not demonstrate a significant benefit in reduction of weight, change in creatinine or improvement in all-cause mortality.
- © 2013 by American Heart Association, Inc.