| ObjectiveTo compare the efficacy and safety of ultrafiltration and conventional intravenous diuretic therapy in patients with acute heart failure.MethodsSearching on line in the Cochrane library (1993～2011.3),Pubmed (1988～2011.3), Ovid(1984～2011.3), Ebsco(1984～2011.3), CBM (1978～2011.3), VIP (1989～2011.3), CNKI (1979～2011.3) and the HERDIN database. We have included randomised controlled trials comparing the efficacy of ultrafiltration and intravenous diuretics in acute heart failure and assessed the risk of bias in included studies by addressing specific domains (sequence generation, allocation concealment, blinding, incomplete outcome data, selective outcome reporting and other issues) as set out in the Cochrane Handbook5.0for Systematic Reviews of Interventions. We analyzed the data and pooled them using Revman5.0when appropriate.Results Five trials involving289participants were included. Meta-analysis of the pooled data showed that ultrafiltration was significantly better than diuretic drugs based on48-h weight loss Z=5.87, P<0.01, weighted mean difference (WMD)=1.77,95%CI [1.18to2.36] and on48-hour fluid removal Z=5.08, P<0.01, WMD=1.21,95%CI [0.74to1.68]. Ultrafiltration was associated with a48-h creatinine level similar to that in the diuretic group Z=1.14, P=0.26, OR=1.33,95%CI[0.81to2.16].ConclusionsAvailable evidence suggests that ultrafiltration is effective and safe in the management of acute heart failure. It provided greater weight loss and fluid removal by48h than did intravenous diuretic.48hours after application, a similar level with diuretic and no adverse effects on renal function. However these conclusions are based on a small number of studies involving relatively few people; methodological study was not always high, and the possibility of bias could not be excluded. More high-quality randomized controlled trials are needed to verify these findings. |
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