Please use this identifier to cite or link to this item: http://hdl.handle.net/1942/31401
Title: Acetazolamide to increase natriuresis in congestive heart failure at high risk for diuretic resistance
Authors: VERBRUGGE, Frederik 
MARTENS, Pieter 
AMELOOT, Koen 
Haemels, Veerle
PENDERS, Joris 
DUPONT, Matthias 
Tang, Wai Hong Wilson
Droogne, Walter
MULLENS, Wilfried 
Issue Date: 2019
Publisher: WILEY
Source: European journal of heart failure, 21 (11) , p. 1415 -1422
Abstract: Aims To investigate the effects of acetazolamide on natriuresis, decongestion, kidney function and neurohumoral activation in acute heart failure (AHF). Methods and results This prospective, two-centre study included 34 AHF patients on loop diuretics with volume overload. All had a serum sodium concentration < 135 mmol/L and/or serum urea/creatinine ratio > 50 and/or an admission serum creatinine increase of > 0.3 mg/dL compared to baseline. Patients were randomised towards acetazolamide 250-500 mg daily plus bumetanide 1-2 mg bid vs. high-dose loop diuretics (bumetanide bid with daily dose twice the oral maintenance dose). The primary endpoint was natriuresis after 24 h. Natriuresis after 24 h was similar in the combinational treatment vs. loop diuretic only arm (264+/-126 vs. 234+/-133 mmol; P = 0.515). Loop diuretic efficiency, defined as natriuresis corrected for loop diuretic dose, was higher in the group receiving acetazolamide (84+/-46 vs. 52+/-42 mmol/mg bumetanide; P = 0.048). More patients in the combinational treatment arm had an increase in serum creatinine levels > 0.3 mg/dL (P = 0.046). N-terminal pro-B-type natriuretic peptide reduction and peak neurohumoral activation within 72 h were comparable among treatment arms. There was a non-significant trend towards lower all-cause mortality or heart failure readmissions in the group receiving acetazolamide with low-dose loop diuretics vs. high-dose loop diuretic monotherapy (P = 0.098). Conclusion Addition of acetazolamide increases the natriuretic response to loop diuretics compared to an increase in loop diuretic dose in AHF at high risk for diuretic resistance. Trial registration: ClinicalTrials.gov NCT01973335.
Notes: Verbrugge, FH (reprint author), Ziekenhuis Oost Limburg, Dept Cardiol, Schiepse Bos 6, B-3600 Genk, Belgium.
frederik.verbrugge@zol.be
Keywords: Acetazolamide;Cardiorenal syndrome;Diuretics;Natriuresis;Systolic heart failure
Document URI: http://hdl.handle.net/1942/31401
ISSN: 1388-9842
e-ISSN: 1879-0844
DOI: 10.1002/ejhf.1478
ISI #: WOS:000497176400015
Rights: 2019 European Society of Cardiology.
Category: A1
Type: Journal Contribution
Validations: ecoom 2020
Appears in Collections:Research publications

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