The Efficacy And Safety Of Ultrafiltration And Intravenous Diuretics In The Treatment Of Cardiorenal Syndrome——A Meta-Analysis

Objective: The purpose of this meta-analysis was to compare the efficacy and safety of ultrafiltration with intravenous diuretics in the treatment of cardiorenal syndrome.Methods: The PubMed、EMBASE、Cochrane library、Web of science、Chinese National Knowledge Infrastructure Database 、 Weipu Database and China Biomedical Literature Database were searched from inception to december 2018 for randomized controlled trials.A literature on the efficacy of diuretics in the treatment of cardio-renal syndrome,a total of 10 randomized controlled trials were included,and the baseline characteristics,interventions,and related outcomes of each controlled trial were extracted.Quality assessment was performed using the Jadad scale.The heterogeneity test was performed using the I2 value,the odds ratio(OR)was calculated using the fixed effect model for the heterogeneous data,and the standardized mean difference was calculated using the random effect model for the heterogeneous data(StandardMean Difference),SMD).Results: A total of 10 randomized controlled trials were included in 917 patients,including 457 patients in the control group(intravenous diuretics)and460 patients in the experimental group(ultrafiltration).The results of this meta-analysis show that:(1)In terms of weight loss,ultrafiltration is more advantageous than intravenous diuretics(SMD=1.22,95% CI: 0.28~2.15,P=0.01);(2)in terms of liquid removal Ultrafiltration is more advantageous than intravenous diuretics(SMD=1.04,95% CI: 0.57~1.52,P<0.0001);(3)There is no significant difference between ultrafiltration and intravenous diuretics in improving serum creatinine value(SMD = 0.02,95% CI:-0.03 ~ 0.07,P =0.47);(4)There was no significant difference between ultrafiltration and intravenous diuretics in improving brain pro-peptide precursors(SMD =-38.14,95)%CI:-119.76~43.48,P=0.36);(5)In reducing the rate of rehospitalization,ultrafiltration is more advantageous than intravenous diuretics(OR=0.60,95%CI: 0.43~0.84,P=0.003)(6)In terms of all-cause mortality,there was no significant difference between ultrafiltration and intravenous diuretics(OR=1.06,95% CI: 0.71 to 1.58,P=0.79).Conclusion: The results of this meta-analysis suggest that ultrafiltration can reduce body weight and remove excess fluid more effectively than intravenous intravenous diuretics in patients with cardiorenal syndrome.Ultrafiltration can also effectively reduce rehospitalization rate in patients with cardiorenal syndrome.But in terms of improving kidney function,improving NT-proBNP and all-cause mortality,there was no significant difference between ultrafiltration and intravenous diuretics.