Tay Kirsty Luo-Yng, Osman Abdel Rahman, Yeoh Esyn Ee Xin, Luangboriboon Jasmine, Lau Jie Fei, Chan Joanne Jia An, Yousif Majed, Tse Benjamin Yi Hong, Horgan Graham, Gamble David T, Myint Phyo Kyaw
School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen AB25 2ZD, UK.
Biomathematics & Statistics Scotland, Aberdeen AB25 2ZD, UK.
J Clin Med. 2023 Apr 9;12(8):2793. doi: 10.3390/jcm12082793.
Existing systematic reviews have insufficiently delineated the differing cardiac and renal profile of ultrafiltration compared to diuretics as a method of decongestion in acute decompensated heart failure. This meta-analysis will investigate the impact of ultrafiltration compared to diuretics on prognostic cardiac and renal biomarkers. We searched PubMed Central, Ovid MEDLINE, Ovid Embase, all EBM reviews, and Web of Science Core Collection for randomised controlled trials published before 21 July 2022. Our main outcome measures were cardiac (brain natriuretic peptide and N-terminal pro-brain natriuretic peptide) and renal biomarkers (serum creatinine, serum sodium, and blood urea nitrogen). A total of 10 randomised trials were included in our analysis after screening. An inverse-variance random effects meta-analysis of the pooled results demonstrated no significant difference between ultrafiltration and diuretics for brain natriuretic peptide, N-terminal pro-brain natriuretic peptide, creatinine, sodium and long-term blood urea nitrogen. However, ultrafiltration produced statistically greater increases in blood urea nitrogen in the short-term (mean difference, 3.88; 95% confidence interval 0.59-7.17 mg/dL). Overall, ultrafiltration produces a similar impact on prognostic cardiac and renal biomarkers when compared to diuretic therapy. We highlight ultrafiltration's significant impact on short-term BUN and recommend further research to investigate more optimal protocols of ultrafiltration administration.
与利尿剂相比，作为急性失代偿性心力衰竭的一种去充血方法，现有系统评价对超滤不同的心脏和肾脏特征描述不足。本荟萃分析将研究超滤与利尿剂相比对心脏和肾脏预后生物标志物的影响。我们检索了PubMed Central、Ovid MEDLINE、Ovid Embase、所有循证医学综述以及Web of Science核心合集，以查找2022年7月21日前发表的随机对照试验。我们的主要结局指标是心脏生物标志物（脑钠肽和N末端脑钠肽前体）和肾脏生物标志物（血清肌酐、血清钠和血尿素氮）。经过筛选，共有10项随机试验纳入我们的分析。对汇总结果进行的逆方差随机效应荟萃分析表明，超滤与利尿剂在脑钠肽、N末端脑钠肽前体、肌酐、钠和长期血尿素氮方面无显著差异。然而，超滤在短期内使血尿素氮有统计学意义的更大升高（平均差值为3.88；95%置信区间为0.59 - 7.17 mg/dL）。总体而言，与利尿剂治疗相比，超滤对心脏和肾脏预后生物标志物的影响相似。我们强调超滤对短期血尿素氮的显著影响，并建议进一步研究以探讨更优化的超滤给药方案。
