Systematic review of clinical benefit of ultrafiltration and diuretics for decompensated heart failure with reduced ejection fraction
Zhang Dexin
Li Huijun
Yin Fuqiang
Zhang Chao
Abstract：Objective Ultrafiltration(UF)can be used to clear fluids in patients with decompensated heart failure with reduced ejection fraction(HFr EF)that are not effective for diuretics,However,current evidence on ultrafiltration and diuretics in HFr EF patients is still insufficient.Methods Electronic databases,including PubMed,Embase,Cochrane Library,CNKI,Wanfang and VIP,were searched systematically to identify all relevant clinical trials.Relative risk(RR)or mean differences(MD)with their 95%confidence intervals(CI)were calculated using random effects models for all-cause readmission rates,unscheduled outpatient or emergency department visits,renal failure rates(creatinine>0.03 mg/dl),hypotension rates(systolic blood pressure<90 mmHg),mean creatinine elevation levels,clear water loss,length of stay,blood sodium levels,mean weight loss levels,efficacy of clinical management of heart failure,changes in B type natriuretic peptide(BNP)levels,and the average number of outpatient or emergency department visits over 30 days were compared.Results A total of 12 clinical trials including 1041 patients(515 UF,526 diuretics)were included in the analysis.At a median follow-up of 90 days,compared with patients treated with diuretics,patients treated with UF had higher rates of all-cause hospitalization(RR=0.94,95%CI:0.71～1.25),heart failure-related readmissions(RR=0.46,95%CI:0.20～1.05),unscheduled outpatient visits(RR=1.07,95%CI:0.38～3.01)and length of stay(MD=-0.87,95%CI:-3.66～1.93)were not significantly different.Between the two groups,the rates of renal failure(RR=1.17,95%CI:0.80～1.69),clear water loss(MD=-1.61,95%CI:-3.67～0.45),clinically significant rate(RR=1.18,95%CI:0.94～1.49)and clinical efficiency(RR=1.10,95%CI:0.72～1.68)of The data were also similar.In terms of hypotension rate(RR=0.49,95%CI:0.25～0.94),blood sodium level(MD=-2.22,95%CI:-3.18～-1.26),mean weight loss level(MD=-1.62,95%CI:-2.39～-0.85),clinical futility rate(RR=0.41,95%CI:0.20～0.84)and the mean number of outpatient or emergency visits within 30 days(RR=-0.32,95%CI:-0.42～-0.22)were lower in the UF group than in the diuretic group.The UF group had higher creatinine levels(MD=0.12,95%CI:0.01～0.22),total clinical efficiency(RR=1.16,95%CI:1.03～1.31)and BNP levels(MD=2.80,95%CI:2.27～3.33)than the diuretic group.Conclusion In patients with HFrEF,UF and diuretics had comparable clinical benefits in reducing all-cause hospitalizations,readmissions for heart failure,unplanned outpatient or emergency department visits,renal failure,net water loss,and length of stay outcomes.UF was superior in hypotension,mean weight loss,and mean visits to the clinic or emergency department within 30 days,while diuretic was superior in creatinine levels,changes in blood sodium levels,and mean increase in BNP.In terms of clinically valid outcomes,UF performed better in overall effective and ineffective outcomes,while similar effects were observed in both effective and effective outcomes.Therefore,the clinical efficacy and safety of UF and diuretics in patients with HFrEF are similar.
Keywords：Heart failureEjection fractionUltrafiltrationDiureticsMeta-analysis
Publication Date：2023-08-28
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：9( 920-927,931 )