Vol.:(0123456789) 1 3 https://doi.org/10.1007/s10741-020-10057-7 Ultrafltration is better than diuretic therapy for volume‑overloaded acute heart failure patients: a meta‑analysis Bastian Wobbe 1  · Juliane Wagner 1  · Dorottya Kata Szabó 1  · Ildikó Rostás 2  · Nelli Farkas 2  · András Garami 2  · Márta Balaskó 2  · Petra Hartmann 4  · Margit Solymár 2  · Judit Tenk 2  · Máté Ottófy 2  · Arnold Nagy 3  · Tamás Habon 1  · Péter Hegyi 2  · László Czopf 1,5 Accepted: 16 November 2020 © The Author(s) 2020 Abstract Studies on the efectiveness of ultrafltration (UF) in patients hospitalized with acute decompensated heart failure (ADHF) have led to heterogeneous study outcomes. This meta-analysis aimed to assess the impact of UF therapy in ADHF patients. We searched the medical literature to identify well-designed studies comparing UF with the usual diuretic therapy in this setting. Systematic evaluation of 8 randomized controlled trials enrolling 801 participants showed greater fuid removal (diference in means 1372.5 mL, 95% CI 849.6 to 1895.4 mL; p < 0.001), weight loss (diference in means 1.592 kg, 95% CI 1.039 to 2.144 kg; p < 0.001) and lower incidences of worsening heart failure (OR 0.63, 95% CI 0.43 to 0.94, p = 0.022) and rehospitalization for heart failure (OR 0.54, 95% CI 0.36 to 0.82, p = 0.003) without a diference in renal impairment (OR 1.386, 95% CI 0.870 to 2.209; p = 0.169) or all-cause mortality (OR 1.13, 95% CI 0.75 to 1.71, p = 0.546). UF increases fuid removal and weight loss and reduces rehospitalization and the risk of worsening heart failure in congestive patients, suggesting ultrafltration as a safe and efective treatment option for volume-overloaded heart failure patients. Keywords Acute heart failure · Ultrafltration · Diuretics · Meta-analysis Abbreviations UF Ultrafltration ADHF Acute decompensated heart failure UC Usual care RCT Randomized controlled trial OR Odds ratio CI Confdence interval DM Diabetes mellitus ACE Angiotensin-converting enzyme ARB Angiotensin II receptor blocker NYHA New York Heart Association HF Heart failure Introduction Heart failure (HF) is a clinical syndrome characterized by a group of symptoms (e.g., dyspnea, fatigue, and ankle swell- ing) and signs (e.g., pulmonary crackles and peripheral edema) [1]. Acute decompensation is a common complica- tion in patients with chronic HF. Ultrafltration (UF) is an upcoming treatment alterna- tive for patients hospitalized for acute decompensated heart failure (ADHF). Fluid overload remains the main cause of heart failure hospitalization and is driven by sodium and water retention.[2] Thus, decongestion is one of the primary targets of therapy. Mostly, decongestion has been accomplished through diu- retic treatment. While 88% of afected patients are treated with diuretics, many show suboptimal responses, and hos- pital readmission rates remain high (25% within 30 days) [3, 4]. Concerns related to the safety and efcacy of diuretic * László Czopf laszlo.czopf@aok.pte.hu 1 Division of Cardiology, 1st Department of Medicine, University of Pécs Medical School, Pécs, Hungary 2 Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary 3 Department for Pediatrics, University of Pécs Medical School, Pécs, Hungary 4 Institute of Surgical Research, University of Szeged, Szeged, Hungary 5 Division of Cardiology, 1st Department of Medicine, University of Pécs Medical School, Ifúság u. 13., Pécs H-7624, Hungary / Published online: 26 November 2020 Heart Failure Reviews (2021) 26:577–585