SESSION TYPE: Heart Failure
PRESENTED ON: Sunday, October 21, 2012 at 10:30 AM - 11:45 AM
PURPOSE: Intravenous (IV) diuretics are commonly used for the treatment of hospitalized patients with decompensated heart failure (HF), and can induce electrolyte abnormalities, acute kidney injury, and tinnitus. Extracorporeal ultrafiltration (UF) is an invasive therapy that has shown some promise for the treatment of decompensated HF with improvement in extracellular fluid volume and reduction in hospital readmissions. We conducted a meta-analysis of on the potential benefits of UF vs. IV diuretics in patients with decompensated HF.
METHODS: We performed a literature search in PubMed, Cochrane Database, EMBASE (inception through February 15, 2012) using predefined criteria and specific terms, and reviewed proceedings from relevant scientific meetings. Randomized controlled trials (RCTs) comparing the efficacy of UF vs. IV diuretics on clinical, hemodynamic, and humoral parameters in patients with DHF were included. Random-effects (for continuous outcomes) and (Peto) fixed-effect (for binary outcomes) model meta-analyses were performed. Heterogeneity among individual study effect estimates was assessed using the I2 index.
RESULTS: 5 RCTs (343 analyzable patients) were included. UF (average duration 31±3 hours) resulted in a significant net fluid removal of 1609 ml (95% confidence interval [CI] -1006, -2212 ml; P < 0.001; I2 = 2%) relative to IV diuretics, but a non-significant net weight loss of 2.9 kg (95% CI -6.6, 0.9 kg; P = 0.13, I2 = 98%). UF was also associated with a net reduction in circulating NT-proBNP level of 1192 pg/ml (95% CI −1748, −636 pg/ml; P < 0.001, I2 = 0%) relative to IV diuretics. There was no observed effect of UF on mortality relative to IV diuretics (odds ratio 1.033; 95% CI 0.512, 2.083, P = 0.93 I2 = 0%).
CONCLUSIONS: Compared to IV diuretics, extracorporeal UF is associated with more fluid removal, which is paralleled by a predictable decrease in circulating NT-proBNP levels. Although UF did not have an effect on mortality, analyses of other potential adverse effects of the therapy could not be ascertained.
CLINICAL IMPLICATIONS: Based on this meta-analysis of a small number of RCTs, extracorporeal UF appears to be more effective than IV diuretics at removing extracellular fluid volume and improving circulating NT-proBNP levels in patients with decompensated HF. Ongoing large multicenter studies are expected to provide insights into the short- and long-term benefits and potential harms of this invasive extracorporeal therapy.
DISCLOSURE: The following authors have nothing to disclose: Khagendra Dahal, Cristian Riella, Fouad Chebib, Diana Revenco, Paweena Susantitaphong, Lana Tsao, Michael Maysky, Bertrand Jaber
No Product/Research Disclosure InformationSt. Elizabeth's Medical Center, Department of Medicine, Tufts University School of Medicine, Boston, MA