title: Effect of ultrafiltration versus intravenous furosemide for decompensated heart failure in cardiorenal syndrome: a systematic review with meta-analysis of randomized controlled trials.
abstract: 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 decompensated 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% CI, 0.29-2.59; p = 0.01). The difference of fluid removal was 1.28 l between groups (95% CI, 0.43-2.12; p = 0.003). The RR for mortality was 0.90 for ultrafiltration compared with diuretics (95% CI, 0.61-1.33; p = 0.60) and the RR for renal function deterioration was 1.29 (95% CI, 0.90-1.85; p = 0.17). There is a trend toward reducing readmission rate in ultrafiltration group.
  
  
  CONCLUSIONS
  Ultrafiltration is a safe and effective strategy in the treatment of cardiorenal syndrome without increasing the risk of renal deterioration.
authors.affiliation: Division of Nephrology, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, and School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Hsin-Yu
authors.initials: HY
authors.lastname: Chen
authors.forename: Kang-Ju
authors.initials: KJ
authors.lastname: Chou
authors.forename: Hua-Chang
authors.initials: HC
authors.lastname: Fang
authors.forename: Chien-Liang
authors.initials: CL
authors.lastname: Chen
authors.forename: Chih-Yang
authors.initials: CY
authors.lastname: Hsu
authors.forename: Wei-Chieh
authors.initials: WC
authors.lastname: Huang
authors.forename: Chien-Wei
authors.initials: CW
authors.lastname: Huang
authors.forename: Chun Kai
authors.initials: CK
authors.lastname: Huang
authors.forename: Po-Tsang
authors.initials: PT
authors.lastname: Lee
mesh_terms: D059347:Cardio-Renal Syndrome / Q000150:complications / Q000188:drug therapy* / Q000628:therapy*; D004232:Diuretics / Q000627:therapeutic use*; D005665:Furosemide / Q000627:therapeutic use*; D006333:Heart Failure / Q000188:drug therapy* / Q000209:etiology / Q000628:therapy*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D014462:Ultrafiltration
chemical_list: D004232:Diuretics; D005665:Furosemide