Effi cacy and Renal Tolerability of Ultrafi ltration in Acute Decompensated Heart Failure: A Meta-analysis and Systematic Review of 19 Randomized Controlled Trials

Background:Acute decompensated heart failure(ADHF)is a life-threatening and costly disease.Controversy re-mains regarding the effi cacy and renal tolerability of ultrafi ltration for treating ADHF.We therefore performed this meta-analysis to evaluate this clinical issue.Methods:A search of PubMed,EMBASE,and the Cochrane database of controlled trials was performed from in-ception to March 2021 for relevant randomized controlled trials.The quality of the included trials and outcomes was evaluated with the use of the risk of bias assessment tool and the Grading of Recommendations,Assessment,Develop-ment and Evaluation(GRADE)approach,respectively.The risk ratio and the standardized mean difference(SMD)or weighted mean difference(WMD)were computed and pooled with fi xed-effects or random-effects models.Results:This meta-analysis included 19 studies involving 1281 patients.Ultrafi ltration was superior to the control treatments for weight loss(WMD 1.24 kg,95%confi dence interval[CI]0.38-2.09 kg,P=0.004)and fl uid removal(WMD 1.55 L,95%CI 0.51-2.59 l,P=0.003)and was associated with a signifi cant increase in serum creatinine level compared with the control treatments(SMD 0.15 mg/dL,95%CI 0.00-0.30 mg/dL,P=0.04).However,no signifi cant effects were found for serum N-terminal prohormone of brain natriuretic peptide level,length of hospital stay,all-cause mortality,or all-cause rehospitalization in the ultrafi ltration group.Conclusions:The use of ultrafi ltration in patients with ADHF is superior to the use of the control treatments for weight loss and fl uid removal,but has adverse renal effects and lacks signifi cant effects on long-term prognosis,in-dicating that this approach to decongestion in ADHF patients is effi cient for fl uid management but less safe renally.