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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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Verbrugge_Frederik_H_2019.pdf Restricted Access | Published version | 1.74 MB | Adobe PDF | View/Open Request a copy |
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