• Hanchun Wen, Yougui Zhang, Jijin Zhu, Yunyun Lan, and Han Yang.
• Emergency Department, First Affiliated Hospital of Guangxi Medical University, Nanning, China, nnawen@163.com.
• Am J Cardiovasc Drugs. 2013 Oct 1;13(5):365-73.

BackgroundPatients with decompensated heart failure frequently present with volume overload, which is conventionally treated with diuretics. These drugs have been associated with several adverse effects, including increased mortality, leading some clinicians to propose ultrafiltration as a safe alternative to remove sodium and water.ObjectiveThe objective of our study was to compare the safety and efficacy of ultrafiltration and conventional intravenous diuretic therapy for patients with acute heart failure and volume overload.Data SourcesWe searched the following databases through November 2012: Cochrane Library (1993-), PubMed (1988-), OVID (1984-), EBSCO (1984-), CBM (1978-), VIP (1989-), and CNKI (1979-). In addition, we manually searched relevant references and review articles.Study SelectionRandomized controlled trials comparing the efficacy of ultrafiltration and intravenous diuretics in patients diagnosed with hypervolemic acute heart failure were included. Five trials were found to satisfy all the inclusion criteria.Study Appraisal And Synthesis MethodsTwo reviewers independently determined study eligibility, assessed methodological quality and extracted the data. We analyzed the data and pooled them, when appropriate, using Revman 5.0. We assessed the risk of bias in the included studies using guidelines in the Cochrane Handbook 5.0 for Systematic Reviews of Interventions, taking into account sequence generation, allocation concealment, blinding, incomplete outcome data, and selective outcome reporting.ResultsData from the initial phase of five trials involving 477 participants were included. Meta-analysis of the pooled data showed that ultrafiltration was significantly better than diuretic drugs based on 48-h weight loss (Z = 3.72; P < 0.001, weighted mean difference [WMD] = 1.25 kg, 95 % CI 0.59-1.91) and based on 48-h fluid removal (Z = 4.23; P < 0.001, WMD = 1.06 L, 95 % CI 0.57-1.56). Adverse events did not differ significantly between the ultrafiltration and intravenous diuretic treatment groups.LimitationsThere are several limitations to our review, including publication bias and selection bias. Our review included only a few studies involving relatively few participants.ConclusionsThe available evidence suggests that early ultrafiltration is safe and effective for patients with hypervolemic acute heart failure. It allows greater fluid removal and weight loss by 48 h than do intravenous diuretics, with no significant increase in adverse effects.

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