Cheng Zhong, Wang Lan, Gu Ye, Hu Shao
Heart Center at Puai Hospital, Wuhan Puai Hospital, Huazhong University of Science and Technology.
Int Heart J. 2015 May 13;56(3):319-23. doi: 10.1536/ihj.14-303. Epub 2015 Apr 23.
Ultrafiltration (UF) is an alternative strategy to diuretic therapy for the treatment of patients with decompensated heart failure. The impact of UF in decompensated heart failure with renal insufficiency remains unclear. A literature search was conducted for randomized controlled trials (RCTs) that investigated the use of UF in decompensated heart failure patients with renal insufficiency.Seven RCTs with 569 participants were eligible for analysis. There was significantly more 48 hour weight loss (WMD 1.59, 95% CI 0.32 to 2.86; P = 0.01; I2 = 68%) and 48 hour fluid removal (WMD 1.23, 95% CI 0.63 to 1.82; P < 0.0001; I2 = 43%) in the UF group compared to the control group. Serum creatinine (WMD 0.05; 95% CI -0.23 to 0.33; P = 0.61; I2 = 77%) and serum creatinine changes (WMD 0.05; 95% CI -0.15 to 0.26; P = 0.61; I2 = 77%) were similar between the UF and control groups. All-cause mortality (OR 0.95; 95% CI 0.58 to 1.55; P = 0.83; I2 = 0.0%) and all-cause rehospitalization (OR 0.97; 95% CI 0.49 to 1.92; P = 0.94; I2 = 52%) were also similar between the UF and control groups. Adverse events such as infection, anemia, hemorrhage, worsening heart failure, and other cardiac disorders did not differ significantly between the UF and control groups.UF is an effective and safe therapeutic strategy and produces greater weight loss and fluid removal without affecting renal function, mortality, or rehospitalization in patients with decompensated heart failure complicated by renal insufficiency.
超滤（UF）是治疗失代偿性心力衰竭患者的一种替代利尿治疗的策略。超滤在伴有肾功能不全的失代偿性心力衰竭中的作用仍不明确。我们进行了一项文献检索，以查找调查超滤在伴有肾功能不全的失代偿性心力衰竭患者中应用的随机对照试验（RCT）。七项包含569名参与者的RCT符合分析条件。与对照组相比，超滤组48小时体重减轻显著更多（加权均数差[WMD] 1.59，95%可信区间[CI] 0.32至2.86；P = 0.01；I² = 68%），48小时液体清除量也显著更多（WMD 1.23，95% CI 0.63至1.82；P < 0.0001；I² = 43%）。超滤组和对照组之间血清肌酐（WMD 0.05；95% CI -0.23至0.33；P = 0.61；I² = 77%）及血清肌酐变化（WMD 0.05；95% CI -0.15至0.26；P = 0.61；I² = 77%）相似。超滤组和对照组之间全因死亡率（比值比[OR] 0.95；95% CI 0.58至1.55；P = 0.83；I² = 0.0%）及全因再住院率（OR 0.97；95% CI 0.49至1.92；P = 0.94；I² = 52%）也相似。超滤组和对照组之间感染、贫血、出血、心力衰竭恶化及其他心脏疾病等不良事件无显著差异。超滤是一种有效且安全的治疗策略，在伴有肾功能不全的失代偿性心力衰竭患者中能实现更多的体重减轻和液体清除，且不影响肾功能、死亡率或再住院率。
