Highlights
- •Patients with heart failure with reduced ejection fraction who develop resistance to diuretics have limited options.
- •Ultrafiltration is an alternative option for removal of excessive fluid in diuretic resistant patients presenting with exacerbation of heart failure.
- •Efficacy and safety of ultrafiltration is comparable to that of diuretics.
Abstract
Background
Ultrafiltration (UF) is used for fluid removal patients with acute decompensated heart
failure with reduced ejection fraction (HFrEF) refractory to diuretics. However, data
on the relative merits of UF and diuretics are limited.
Methods
Online databases were queried to identify clinical trials on the comparison of UF
and diuretics. The major adverse cardiovascular (MACE) and its components (mortality
and re-hospitalizations) were compared using the random-effects model to calculate
the unadjusted odds ratio (OR) with its 95% confidence interval (CI).
Results
A total of 10 clinical trials comprising 838 patients (413 UF, 425 diuretics) were
included in the analysis. At a median follow-up of 90 days, there was no significant
difference in the odds of MACE (OR 0.71, 95% CI 0.47–1.07) and all-cause mortality
(OR 1.08, 95% CI 0.77–1.52) between patients undergoing UF compared with those receiving
diuretics therapy. The need for emergency department visits (OR 1.05, 95% CI 0.38–2.90),
all-cause admissions (OR 0.97, 95% CI 0.72–1.30) and heart failure-related re-hospitalization
(OR 0.47, 95% CI 0.21–1.02) was also similar between the two groups. The in-hospital
risk for hypotension (OR 0.49, 0.23–1.04) and post-therapy creatinine rise>0.3 mg/dL
(OR 1.18, 95% CI 0.74–1.89) was also not significantly different between the UF and
diuretics arms. A sensitivity analysis of MACE and mortality did not show any deviation
from the pooled outcomes.
Conclusions
In patients with HFrEF, UF appears to be safe but might not provide significant benefits
in terms of reducing the risk of mortality or readmission rates compared with those
treated with diuretics.
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Article info
Publication history
Published online: May 27, 2022
Accepted:
May 11,
2022
Received in revised form:
May 4,
2022
Received:
February 25,
2022
Identification
Copyright
© 2022 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
