Uremic patients are prone to complicated acute left heart failure, with 30–50% progressing to respiratory failure. Conventional treatments struggle to rapidly correct volume overload and gas exchange disorders. The efficacy and safety of hemodialysis combined with noninvasive positive pressure ventilation (NPPV) remain controversial, necessitating evidence from evidence-based medicine. Randomized controlled trials (RCTs) were extracted from PubMed, Cochrane Library, Embase, CNKI, and Wanfang Database, encompassing all records from their establishment up to June 2025. A total of 15 studies with 1444 participants were included. The experimental group was administered hemodialysis in combination with non-invasive positive pressure ventilation (NPPV), while the control group received conventional treatment or single hemodialysis/NPPV. Outcome measures comprised treatment success rate, oxygenation index (PaO2/FiO2), serum creatinine, length of hospital stay, and adverse reaction rate. Meta-analysis was performed using RevMan 5.4. Continuous data were presented as mean difference (MD), and categorical data as relative risk (RR), with 95% confidence intervals (CI) calculated. The experimental group exhibited a significantly higher treatment success rate compared to the control group (RR = 1.32, 95% CI 1.18–1.48, P < 0.001, I2 = 32%). Post-treatment, the oxygenation index (PaO2/FiO2) in the experimental group was significantly elevated (MD = 68.42 mmHg, 95% CI 52.16–84.68, P < 0.001, I2 = 28%). Serum creatinine levels in the experimental group were significantly lower (MD = −126.5 μmol/L, 95% CI −142.3 to −110.7, P < 0.001, I2 = 41%). The length of hospital stay in the experimental group was significantly shorter (MD = −3.8 days, 95% CI −4.5 to −3.1, P < 0.001, I2 = 15%). There was no significant difference in the incidence of adverse reactions between the two groups (RR = 1.15, 95% CI 0.76–1.73, P = 0.51, I2 = 63%). Egger's test indicated no significant publication bias (P = 0.13), and the funnel plot was essentially symmetrical. Hemodialysis combined with NPPV can significantly improve the therapeutic effect in patients with uremia complicated with acute left heart failure and respiratory failure, with good safety, and is worthy of clinical promotion.
Peng et al. (Fri,) studied this question.