title: Meta-Analysis of Ultrafiltration versus Diuretics Treatment Option for Overload Volume Reduction in Patients with Acute Decompensated Heart Failure.
abstract: Although diuretics are mainly used for the treatment of acute decompensated heart failure (ADHF), inadequate responses and complications have led to the use of extracorporeal ultrafiltration (UF) as an alternative strategy for reducing volume overloads in patients with ADHF.
  
  
  
  The aim of our study is to perform meta-analysis of the results obtained from studies on extracorporeal venous ultrafiltration and compare them with those of standard diuretic treatment for overload volume reduction in acute decompensated heart failure.
  
  
  
  MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials databases were systematically searched using a pre‑specified criterion. Pooled estimates of outcomes after 48 h (weight change, serum creatinine level, and all-cause mortality) were computed using random effect models. Pooled weighted mean differences were calculated for weight loss and change in creatinine level, whereas a pooled risk ratio was used for the analysis of binary all-cause mortality outcome.
  
  
  
  A total of nine studies, involving 613 patients, met the eligibility criteria. The mean weight loss in patients who underwent UF therapy was 1.78 kg [95% Confidence Interval (CI): -2.65 to -0.91 kg; p < 0.001) more than those who received standard diuretic therapy. The post-intervention creatinine level, however, was not significantly different (mean change = -0.25 mg/dL; 95% CI: -0.56 to 0.06 mg/dL; p = 0.112). The risk of all-cause mortality persisted in patients treated with UF compared with patients treated with standard diuretics (Pooled RR = 1.00; 95% CI: 0.64-1.56; p = 0.993).
  
  
  
  Compared with standard diuretic therapy, UF treatment for overload volume reduction in individuals suffering from ADHF, resulted in significant reduction of body weight within 48 h. However, no significant decrease of serum creatinine level or reduction of all-cause mortality was observed.
authors: Brigham and Womens Hospital, Boston, MA, USA.
authors: Ebrahim
authors: E
authors: Barkoudah
authors: Ann Arbor, University of Michigan Medical School, Ann Arbor, MI, USA.
authors: Sindhura
authors: S
authors: Kodali
authors: San Diego School of Medicine, San Diego, CA, USA.
authors: Juliet
authors: J
authors: Okoroh
authors: Harvard Medical School, Boston, MA, USA.
authors: Rosh
authors: R
authors: Sethi
authors: Division of Medicine, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
authors: Edward
authors: E
authors: Hulten
authors: Discipline of Geriatrics, Medical School, University of São Paulo, São Paulo, SP, Brazil.
authors: Claudia
authors: C
authors: Suemoto
authors: University Hospital, Medical School, University of São Paulo, São Paulo, SP, Brazil.
authors: Marcio Sommer
authors: MS
authors: Bittencourt
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D001835:Body Weight; D003404:Creatinine / Q000097:blood; D004232:Diuretics / Q000627:therapeutic use*; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000628:therapy*; D006440:Hemofiltration / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D004232:Diuretics; D003404:Creatinine
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