Ultrafiltration for acute decompensated cardiac failure: A systematic review and meta-analysis

Ultrafiltration is a method used to achieve diuresis in acute decompensated heart failure (ADHF) when there is diuretic resistance, but its efficacy in other settings is unclear. We therefore conducted a systematic review and meta-analysis to evaluate the use of ultrafiltration in ADHF.

We searched MEDLINE and EMBASE for studies that evaluated outcomes following filtration compared to diuretic therapy in ADHF. The outcomes of interest were body weight change, change in renal function, length of stay, frequency of rehospitalization, mortality and dependence on dialysis. We performed random effects meta-analyses to pool studies that evaluated the desired outcomes and assessed statistical heterogeneity using the I² statistic.

A total of 10 trials with 857 participants (mean age 68years, 71% male) compared filtration to usual diuretic care in ADHF. Nine studies evaluated weight change following filtration and the pooled results suggest a decline in mean body weight -1.8; 95% CI, -4.68 to 0.97 kg. Pooled results showed no difference between the filtration and diuretic group in change in creatinine or estimated glomerular filtration rate. The pooled results suggest longer hospital stay with filtration (mean difference, 3.70; 95% CI, -3.39 to 10.80days) and a reduction in heart failure hospitalization (RR, 0.71; 95% CI, 0.51-1.00) and all-cause rehospitalization (RR, 0.89; 95% CI, 0.43-1.86) compared to the diuretic group. Filtration was associated with a non-significant greater risk of death compared to diuretic use (RR, 1.08; 95% CI, 0.77-1.52).

There is insufficient evidence supporting routine use of ultrafiltration in acute decompensated heart failure.