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SYSTEMATIC REVIEW article

Front. Cardiovasc. Med.
Sec. Cardiovascular Pharmacology and Drug Discovery
Volume 11 - 2024 | doi: 10.3389/fcvm.2024.1444068

Comparative efficacy of different drugs in acute heart failure with renal dysfunction: a systematic review and network meta-analysis

Provisionally accepted
Qianyu Lv Qianyu Lv 1Qian Wu Qian Wu 1Lanlan Li Lanlan Li 1Yingtian Yang Yingtian Yang 1Xuejiao Ye Xuejiao Ye 1Shihan Wang Shihan Wang 1*Yanfei Lv Yanfei Lv 2Manshi Wang Manshi Wang 3Yushan Li Yushan Li 4
  • 1 Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
  • 2 Fudan University, Shanghai, Shanghai Municipality, China
  • 3 Guangwai Hospital, Xuanwu, China
  • 4 Beijing University of Chinese Medicine, Beijing, Beijing Municipality, China

The final, formatted version of the article will be published soon.

    Abstract Objective: This network meta-analysis was to compare the efficacy of different drugs on cardiac function, renal function, and clinical outcomes in patients with acute heart failure (AHF) accompanied by renal dysfunction. Methods: PubMed, EMBASE, Cochrane Library, and Web of Science were searched to screen all clinical trials of AHF between January 1st 2001 and March 31th 2024. The primary outcome measures were N-terminal pro-B type natriuretic peptide (NT-proBNP), B-type natriuretic peptide (BNP), glomerular filtration rate (GFR), blood urea nitrogen, serum creatinine, all-cause mortality within 60 days, and cardiovascular mortality. Results: After screening 30,697 citations, 13 studies (21,745 patients) were included, and drugs including nesiritide, dopamine, tolvaptan, levosimendan, dobutamine, furosemide, and spirolactone, and high dose of diuretics (HDD, furosemide, and spirolactone) were estimated. The results indicated that HDD had the best efficacy in reducing NT-proBNP levels. In detail, HDD notably reduced NT-proBNP levels compared to conventional treatment or placebo (PLC) (MD=-950.24; 95% CrI [-1832.21, -64.12]). Levosimendan significantly increased GFR levels compared to PLC (MD=14.46; 95% CrI [3.88, 25.97]) and tolvaptan (MD=13.83; 95% CrI [2.31, 25.33]). No significant difference was found in 60-day all-cause mortality and cardiovascular mortality across drugs. Conclusion: HDD showed the best efficacy in reducing NT-proBNP levels compared with dopamine and nesiritide, and levosimendan could significantly improve GFR levels, with no marked difference in the effect of various drugs on 60-day all-cause mortality. Hence, HDD and levosimendan may be optimal agents in the treatment of AHF with renal dysfunction.

    Keywords: acute heart failure, Renal Insufficiency, Diuretics, high dose of diuretics, Network meta-analysis

    Received: 23 Jul 2024; Accepted: 27 Dec 2024.

    Copyright: © 2024 Lv, Wu, Li, Yang, Ye, Wang, Lv, Wang and Li. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Shihan Wang, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.