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Ultrafiltration does provide more efficient decongestion compared to conventional treatment for acute heart failure
IJCA-24334; No of Pages 1 International Journal of Cardiology xxx (2016) xxx
Contents lists available at ScienceDirect
International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard
Correspondence
Ultrafiltration does provide more efficient decongestion compared to conventional treatment for acute heart failure☆ Abhilash Koratala ⁎, Ankur Jain, Amir Kazory Department of Medicine, University of Florida, Gainesville, Florida, USA
a r t i c l e
i n f o
Article history: Received 26 November 2016 Accepted 22 December 2016 Available online xxxx Keywords: Heart Failure, Ultrafiltration, Decongestion
change as the investigators set a fixed weight reduction goal before assigning the patients to treatment arms [3]. Another study (published in Russian, abstract available in English) included hemofiltration which is fundamentally different from ultrafiltration as it involves replacement fluid to provide clearance for renal failure. Surprisingly, Kwok et al. included it in their analysis of glomerular filtration rate [4]. On the other hand, the largest and the best designed trial to this date was not included due to its lack of statistical power, while this indeed represents a setting where meta-analyses could prove the most helpful [5].
Conflict of interest To the Editor, Dr. Kwok and colleagues recently published a meta-analysis comparing the role of ultrafiltration and diuretics in acute heart failure (AHF) and reported on similar impact on weight change (i.e. decongestion) [1]. This unexpected finding merits explanation because it is inconsistent with previously performed meta-analyses and large trials [2]. Congestion is increasingly recognized as a dynamic state capable of modulating the cardiorenal interactions in AHF and independently affecting the outcomes. Current therapies of AHF are hence evaluated on the basis of how well they can provide decongestion. We believe the explanation lies in methodology and study selection by Kwok et al. The authors have added 3 studies to provide an “update” to the most recent meta-analysis, while 2 of them were indeed published previously but had been excluded due to methodological considerations [3,4]. One is based on target weight guided therapy and therefore should not have been included in the analysis of weight
The authors have no potential conflict of interest to declare with respect to this paper.
References [1] C.S. Kwok, C.W. Wong, C.A. Rushton, F. Ahmed, C. Cunnington, S.J. Davies, et al., Ultrafiltration for acute decompensated cardiac failure: A systematic review and metaanalysis, Int. J. Cardiol. 228 (2016) 122–128. [2] A. Jain, N. Agrawal, A. Kazory, Defining the role of ultrafiltration therapy in acute heart failure: a systematic review and meta-analysis, Heart Fail. Rev. 21 (2016) 611–619. [3] E.S. Chung, T.M. O'Brien, S. Menon, C. Bartone, W. Mazur, D.J. Kereiakes, A pilot study of target weight guided treatment in acute heart failure using ultrafiltration or usual care: effect on sodium removal, Korean Circ. J. 44 (2014) 156–161. [4] E.A. Tabak'ian, A.I. Zaruba, R.P. Miasnikov, D.M. Ataullakhanova, V.V. Kukharchuk, Application of methods of renal replacement therapy for abolishment of hyperhydration in patients with decompensated chronic heart failure, Kardiologiia 50 (2010) 30–35. [5] M.R. Costanzo, D. Negoianu, B.E. Jaski, B.A. Bart, J.T. Heywood, I.S. Anand, et al., Aquapheresis Versus Intravenous Diuretics and Hospitalizations for Heart Failure, JACC Heart Fail. 4 (2016) 95–105.
☆ No specific financial support was obtained for preparation of this article. ⁎ Corresponding author at: Division of Nephrology, Hypertension and Renal Transplantation, University of Florida, College of Medicine, 1600 SW Archer Road, Gainesville, FL 32610-0224, USA. E-mail address: [email protected]fl.edu (A. Koratala).
http://dx.doi.org/10.1016/j.ijcard.2016.12.155 0167-5273/© 2016 Elsevier Ireland Ltd. All rights reserved.
Please cite this article as: A. Koratala, et al., Ultrafiltration does provide more efficient decongestion compared to conventional treatment for acute heart failure, Int J Cardiol (2016), http://dx.doi.org/10.1016/j.ijcard.2016.12.155
Contents lists available at ScienceDirect
International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard
Correspondence
Ultrafiltration does provide more efficient decongestion compared to conventional treatment for acute heart failure☆ Abhilash Koratala ⁎, Ankur Jain, Amir Kazory Department of Medicine, University of Florida, Gainesville, Florida, USA
a r t i c l e
i n f o
Article history: Received 26 November 2016 Accepted 22 December 2016 Available online xxxx Keywords: Heart Failure, Ultrafiltration, Decongestion
change as the investigators set a fixed weight reduction goal before assigning the patients to treatment arms [3]. Another study (published in Russian, abstract available in English) included hemofiltration which is fundamentally different from ultrafiltration as it involves replacement fluid to provide clearance for renal failure. Surprisingly, Kwok et al. included it in their analysis of glomerular filtration rate [4]. On the other hand, the largest and the best designed trial to this date was not included due to its lack of statistical power, while this indeed represents a setting where meta-analyses could prove the most helpful [5].
Conflict of interest To the Editor, Dr. Kwok and colleagues recently published a meta-analysis comparing the role of ultrafiltration and diuretics in acute heart failure (AHF) and reported on similar impact on weight change (i.e. decongestion) [1]. This unexpected finding merits explanation because it is inconsistent with previously performed meta-analyses and large trials [2]. Congestion is increasingly recognized as a dynamic state capable of modulating the cardiorenal interactions in AHF and independently affecting the outcomes. Current therapies of AHF are hence evaluated on the basis of how well they can provide decongestion. We believe the explanation lies in methodology and study selection by Kwok et al. The authors have added 3 studies to provide an “update” to the most recent meta-analysis, while 2 of them were indeed published previously but had been excluded due to methodological considerations [3,4]. One is based on target weight guided therapy and therefore should not have been included in the analysis of weight
The authors have no potential conflict of interest to declare with respect to this paper.
References [1] C.S. Kwok, C.W. Wong, C.A. Rushton, F. Ahmed, C. Cunnington, S.J. Davies, et al., Ultrafiltration for acute decompensated cardiac failure: A systematic review and metaanalysis, Int. J. Cardiol. 228 (2016) 122–128. [2] A. Jain, N. Agrawal, A. Kazory, Defining the role of ultrafiltration therapy in acute heart failure: a systematic review and meta-analysis, Heart Fail. Rev. 21 (2016) 611–619. [3] E.S. Chung, T.M. O'Brien, S. Menon, C. Bartone, W. Mazur, D.J. Kereiakes, A pilot study of target weight guided treatment in acute heart failure using ultrafiltration or usual care: effect on sodium removal, Korean Circ. J. 44 (2014) 156–161. [4] E.A. Tabak'ian, A.I. Zaruba, R.P. Miasnikov, D.M. Ataullakhanova, V.V. Kukharchuk, Application of methods of renal replacement therapy for abolishment of hyperhydration in patients with decompensated chronic heart failure, Kardiologiia 50 (2010) 30–35. [5] M.R. Costanzo, D. Negoianu, B.E. Jaski, B.A. Bart, J.T. Heywood, I.S. Anand, et al., Aquapheresis Versus Intravenous Diuretics and Hospitalizations for Heart Failure, JACC Heart Fail. 4 (2016) 95–105.
☆ No specific financial support was obtained for preparation of this article. ⁎ Corresponding author at: Division of Nephrology, Hypertension and Renal Transplantation, University of Florida, College of Medicine, 1600 SW Archer Road, Gainesville, FL 32610-0224, USA. E-mail address: [email protected]fl.edu (A. Koratala).
http://dx.doi.org/10.1016/j.ijcard.2016.12.155 0167-5273/© 2016 Elsevier Ireland Ltd. All rights reserved.
Please cite this article as: A. Koratala, et al., Ultrafiltration does provide more efficient decongestion compared to conventional treatment for acute heart failure, Int J Cardiol (2016), http://dx.doi.org/10.1016/j.ijcard.2016.12.155