Effect of Ultrafiltration versus Intravenous Furosemicie for Decompensated Heart Failure in Carcliorertal Syndromes A Systematic Review with Meta-Analysis of Randomized Controlled Trials

摘要

Background: Ultrafiltration is an adjunctive treatment for decompensated heart failure patients with cardiorenal syndrome. The efficacy and safety of ultrafiltration in the patient cohort are still unknown. Methods: We systematically reviewed and evaluated randomized controlled trials, comparing diuretics with ultrafiltration in adult patients with de-compensated heart failure and cardiorenal syndrome through January 2014. The primary outcomes were body weight loss and total fluid removal. Results: We identified 8 trials including 608 patients. In a random-effects model, the pooled difference of body weight loss was 1.44 kg between patients receiving ultrafiltration and diuretics (95% Cl, 0.29-2.59; p = 0.01). The difference of fluid removal was 1.281 between groups (95% Cl, 0.43-2.12; p = 0.003). The RRfor mortality was 0.90 for ultrafiltration compared with diuretics (95% Cl, 0.61-1.33; p = 0.60) and the RR for renal function deterioration was 1.29 (95% Cl, 0.90-1.85; p = 0.17). There is a trend toward reducing readmission rate in ultrafiltrationgroup. Conclusions: Ultrafiltration is a safe and effective strategy in the treatment of cardiorenal syndrome without increasing the risk of renal deterioration.