Diuretics and ultrafiltration in acute heart failure syndrome.

The use of diuretics and ultrafiltration in acute heart failure syndrome (AHFS) has been investigated in a number of randomized controlled trials (RCTs). However, the benefits have been variable. We therefore performed a meta-analysis to examine the overall effect of all-cause mortality, rehospitalization, renal function, dyspnea relief, and adverse events in patients with AHFS. We identified RCTs by a systematic search of MEDLINE, EMBASE, and the Cochrane Controlled Clinical Trials Register Database. Eligible RCTs were those that enrolled patients with AHFS and involved comparison of diuretic versus ultrafiltration therapy. Five RCTs with a total of nearly 500 patients were included. Overall, ultrafiltration therapy was not associated with significantly decreased risk of all-cause mortality (relative risk [RR], 0.977; 95% confidence interval [CI], 0.602 to 1.587; P = 0.925; I² = 0.0%), rehospitalization (RR, 0.903; 95% CI, 0.696 to 1.170; P = 0.440; I² = 77.4%), dyspnea score (weighted mean difference [WMD], 0.168; 95% CI, -0.318 to 0.653; P = 0.498; I² = 11.4%) and creatinine (WMD, 0.055 mg/mL; 95% CI, -0.101 to 0.210; P = 0.491; I² = 48.4%). However, there was significantly more weight loss (WMD, 1.333 kg; 95% CI, 0.186 to 2.479; P = 0.023; I² = 57.7%) and net fluid removal (WMD, 1459.432 mL; 95% CI, 275.911 to 2642.953; P = 0.016; I² = 25.2%) in the ultrafiltration-therapy group. There was no significant difference in the risk of adverse events between the two groups. Compared with diuretic therapy, ultrafiltration produces greater weight loss and net fluid removal in a safe and effective manner.