Ultrafiltration is better than diuretic therapy for volume-overloaded acute heart failure patients: a meta-analysis

AbstractStudies on the effectiveness of ultrafiltration (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 fluid removal (difference in means 1372.5 mL, 95% CI 849.6 to 1895.4 mL; p < 0.001), weight loss (difference 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 difference 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 fluid removal and weight loss and reduces rehospitalization and the risk of worsening heart failure in congestive patients, suggesting ultrafiltration as a safe and effective treatment option for volume-overloaded heart failure patients.

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Efficacy and Renal Tolerability of Ultrafiltration in Acute Decompensated Heart Failure: A Meta-analysis and Systematic Review of 19 Randomized Controlled Trials

Cardiovascular Innovations and Applications ◽

10.15212/cvia.2021.0020 ◽

2021 ◽

Author(s):

Xin Yuan

Keyword(s):

Heart Failure ◽

Weight Loss ◽

Randomized Controlled Trials ◽

Acute Decompensated Heart Failure ◽

Meta Analysis ◽

Decompensated Heart Failure ◽

Mean Difference ◽

Controlled Trials ◽

Fluid Removal ◽

Randomized Controlled

Background: Acute decompensated heart failure (ADHF) is a life-threatening and costly disease. Controversy remainsregarding the efficacy and renal tolerability of ultrafiltration for treating ADHF. We therefore performed thismeta-analysis to evaluate this clinical issue.Methods: A search of PubMed, EMBASE, and the Cochrane database of controlled trials was performed from inceptionto March 2021 for relevant randomized controlled trials. The quality of the included trials and outcomes wasevaluated with the use of the risk of bias assessment tool and the Grading of Recommendations, Assessment, Developmentand Evaluation (GRADE) approach, respectively. The risk ratio and the standardized mean difference (SMD) or weighted mean difference (WMD) were computed and pooled with fixed-effects or random-effects models.Results: This meta-analysis included 19 studies involving 1281 patients. Ultrafiltration was superior to the controltreatments for weight loss (WMD 1.24 kg, 95% confidence interval [CI] 0.38–2.09 kg, P = 0.004) and fluid removal(WMD 1.55 L, 95% CI 0.51–2.59 l, P = 0.003) and was associated with a significant increase in serum creatinine levelcompared with the control treatments (SMD 0.15 mg/dL, 95% CI 0.00–0.30 mg/dL, P = 0.04). However, no significanteffects were found for serum N-terminal prohormone of brain natriuretic peptide level, length of hospital stay, all-causemortality, or all-cause rehospitalization in the ultrafiltration group.Conclusions: The use of ultrafiltration in patients with ADHF is superior to the use of the control treatments for weight loss and fluid removal, but has adverse renal effects and lacks significant effects on long-term prognosis, indicatingthat this approach to decongestion in ADHF patients is efficient for fluid management but less safe renally.

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

IJC Metabolic & Endocrine ◽

10.1016/j.ijcme.2013.12.002 ◽

2014 ◽

Vol 2 ◽

pp. 19-25 ◽

Cited By ~ 2

Author(s):

Nader Makki ◽

Seth Maliske ◽

Amy Blevins ◽

Saket Girotra ◽

Peter Cram

Keyword(s):

Heart Failure ◽

Systematic Review ◽

Acute Decompensated Heart Failure ◽

Meta Analysis ◽

Decompensated Heart Failure ◽

The Impact

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ALTERATION IN RENAL FUNCTION FOLLOWING LOOP DIURETICS IN PATIENTS WITH ACUTE DECOMPENSATED HEART FAILURE

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2019.v12i12.35574 ◽

2019 ◽

pp. 61-63

Author(s):

PRUDENCE A RODRIGUES ◽

SOUMYA GK ◽

NADIA GRACE BUNSHAW ◽

SARANYA N ◽

SUJITH K ◽

...

Keyword(s):

Heart Failure ◽

Renal Function ◽

Renal Injury ◽

Loop Diuretic ◽

Acute Decompensated Heart Failure ◽

Diuretic Therapy ◽

Decompensated Heart Failure ◽

Loop Diuretics ◽

Contributing Factors ◽

The Impact

Objective: The objective of the study was to monitor the impact of loop diuretic therapy in patients with acute decompensated heart failure (ADHF) and to assess other predictors of renal dysfunction in patients with ADHF. Methods: An observational study over a period of 6 months from January 2018 to June 2018 in the Department of Cardiology, in a Tertiary Care Teaching Hospital, Coimbatore, Tamil Nadu. Patients on diuretic therapy (loop diuretic) were enrolled. Patients with prior chronic kidney disease were excluded from the study. The patients were evaluated based on change in serum creatinine (SCr) and other contributing factors were assessed by acute kidney injury network and worsening of renal function criteria. Results: A total of 135 patients were enrolled, of which 73% were males and 27% were females. The mean age of the subjects was 61.55±13 years. The baseline means SCr was 1.62±0.92 mg/dl. On evaluation, 41% were really affected and 59% remain unaffected. Factors such as hypertension (p=0.047) and angiotensin-converting enzyme inhibitors (ACE-I) (p=0.023) were found to be significant predictors of renal injury. Conclusion: Variation in renal function in ADHF patients was multifactorial. The direct influence of loop diuretics on renal function was present but was not well established. Hypertension and ACE-I have found to show influence in the development of renal injury as contributing factors. There exists both positive and negative consequence of loop diuretics on renal function.

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Effects of a multidisciplinary heart failure program in short term readmissions of heart failure patients, preliminary results

European Heart Journal ◽

10.1093/ehjci/ehaa946.1128 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

J Gorriz Magana ◽

M.J Espinosa Pascual ◽

R Abad Romero ◽

R Olsen Rodriguez ◽

D Nieto Ibanez ◽

...

Keyword(s):

Heart Failure ◽

Acute Decompensated Heart Failure ◽

Decompensated Heart Failure ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Short Term ◽

Ventricular Ejection Fraction ◽

Heart Failure Patients ◽

Basic Characteristics ◽

The Impact

Abstract Background Unexpected readmissions are frequent among heart failure patients, due to their natural history that implies multiple readmissions, with high costs and clinical relevance. Purpose We aimed to assess the impact of a Multidisciplinary Heart Failure Program (MHFP) on the readmission-free period after an episode of acute decompensated heart failure (ADHF). Methods We carried out an analytical and observational study including all patients admitted to our Universitary Hospital, which covers 220,000 individuals, with an episode of heart failure when there was not a Multidisciplinary Heart Failure Program (January 2013 to December 2013). Once the MHFP was established, we compared non-MHFP patients with every patient admitted during February 2019 and February 2020 in terms of clinical data, imaging technique findings and short-term readmissions. Results The rate of readmission during this period was a 24.8% in non-MHFP and 17.2% in MHFP (p=0.15). However, we could find differences in median time to readmission due to ADHF, that was 1.74 months (CI 95%, 0.12–3.35) in non-MHFP, compared to 5.125 months (CI 95%, 4.15–6.09) in MHFP (p=0.002) (see Graph 1). There were also no significant differences in terms of basic characteristics between the MHFP and the non-MHFP patients (age, gender, left ventricular ejection fraction, left bundle branch block, hypertension). It is remarkable that establishing a MHFP has lengthened the readmission-free period. The rate of decompensation in the first and sixth month was respectively in the non–MHFP 9% and 21%; and in the MHFP 2% and 10%. Conclusion According to our results, the implantation of this Multidisciplinary Heart Failure Program has shown a reduction in the time to ADHF readmission compared with a cohort of similar pts some years before, which is clinically relevant. Graph 1 Funding Acknowledgement Type of funding source: None

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Impact of comorbidity on the predictive value of cystatin-C in patients admitted for acute decompensated heart failure: insights from a prospective study

European Heart Journal ◽

10.1093/ehjci/ehaa946.1172 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

K Kayama ◽

T Yamada ◽

T Watanabe ◽

T Morita ◽

Y Furukawa ◽

...

Keyword(s):

Heart Failure ◽

Cystatin C ◽

Charlson Comorbidity Index ◽

Prognostic Value ◽

Roc Analysis ◽

Acute Decompensated Heart Failure ◽

Decompensated Heart Failure ◽

Heart Failure Patients ◽

Comorbidity Index ◽

The Impact

Abstract Background Comorbidities are strongly associated with poor clinical outcome in heart failure patients. The Age-adjusted Charlson comorbidity index (ACCI), which is well-known widely used comorbidity index, recently has been used as a robust prognostic model in heart failure patients. On the other hand, Cystatin C, as a novel and important biomarker of renal function, has been recently reported as a useful long-term risk stratification score in heart failure patients. However, there is no information available on the impact of comorbidities on the prognostic value of cystatin-C in patients admitted for acute decompensated heart failure (ADHF). Methods We prospectively studied 458 consecutive ADHF patients with survival discharge. Patients with hemodialysis were excluded. Echocardiography and venous blood sampling were performed just before discharge and serum cystatin-C level was measured. Comorbidity was measured with the Age-adjusted Charlson comorbidity index (ACCI). ACCI was commonly used for the evaluation of the comorbid condition which is weighted and scored, with additional points added for age. The endpoint was all-cause death (ACD). Results During a follow-up period of 2.8±1.5 years, 132 patients had ACD. At multivariate Cox analysis, ACCI (p=0.0015) and cystatin-C level (p=0.0145) were significantly and independently associated with ACD. Patients with high ACCI (≥6: determined by ROC analysis) had a significantly greater risk of ACD (37.2% vs 17.8%, p<0.0001, HR 2.45 [1.61–3.70]). In the subgroup of higher ACCI, patients with higher cystatin-C level (≥1.56: determined by ROC analysis) had a significantly higher risk of ACD (50.3% vs 23.4%). Furthermore, in the subgroup of lower ACCI, patients with higher cystatin-C level had also significantly higher risk of ACD (34.2% vs 12.1%). Conclusions The prognostic value of cystatin-C is not affected by comorbidities and cystatin-C provide prognostic information even in patients admitted for ADHF, irrespective of comorbid burden. All-cause death-free rate in ADHF pts Funding Acknowledgement Type of funding source: None

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