The impact of ultrafiltration in acute decompensated heart failure: A systematic review and meta-analysis

Background: A number of small studies suggest that ultrafiltration (UF) can improve outcomes in patients with acute decompensated heart failure (ADHF), but substantial uncertainty remains. We conducted a systematic review and meta-analysis with the primary goal of assessing the impact of UF on all-cause mortality in adults with ADHF; the secondary outcomes included re-hospitalization, emergency outpatient visits, and potentially deleterious effects (worsening renal function). Methods: We searched the Medline (1966-2013), the Embase (1966-2013), the Cochrane Registry, the U.S. Clinical Trials databases (2000-2013) and the abstracts from key scientific meetings to identify studies comparing UF with usual care (diuretic therapy) in adults hospitalized with ADHF. We identified six randomized controlled trials enrolling 523 patients. Studies were not heterogeneous and a fixed effect model was used for all analysis. Results: Unadjusted mortality was 13.3% among all diuretic patients as compared to 13.4% among UF recipients (p. = 0.81). When compared to treatment with diuretics alone, UF did not reduce all-cause mortality (HR: 0.99, 95% CI: 0.60 to 1.61; p. = 0.65), re-hospitalizations for HF (HR: 0.96, 95% CI: 0.39 to 2.35; p. = 0.92), or unscheduled visits for heart failure (HR: 0.94, 95% CI: 0.36 to 2.50; p. = 0.84). Furthermore, UF was not associated with increased risk of worsening renal function when compared to diuretic therapy (HR: 1.41, 95% CI: 0.89 to 2.22; p. = 0.89). Conclusions: UF does not appear to reduce mortality, re-hospitalization or unscheduled HF visits in adults with ADHF. At the present time data are insufficient to support routine use of UF for acute HF.