Acetazolamide to increase natriuresis in congestive heart failure at high risk for diuretic resistance
| العنوان: | Acetazolamide to increase natriuresis in congestive heart failure at high risk for diuretic resistance |
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| المؤلفون: | Pieter Martens, W.H. Wilson Tang, Veerle Haemels, Frederik H. Verbrugge, Matthias Dupont, Joris Penders, Walter Droogne, Wilfried Mullens, Koen Ameloot |
| المساهمون: | Clinical sciences, Medicine and Pharmacy academic/administration, Cardiology, Intensive Care |
| المصدر: | European Journal of Heart Failure. 21:1415-1422 |
| بيانات النشر: | Wiley, 2019. |
| سنة النشر: | 2019 |
| مصطلحات موضوعية: | Adult, Male, medicine.medical_specialty, medicine.drug_class, medicine.medical_treatment, Drug Resistance, Volume overload, Natriuresis, Bumetanide/adverse effects, 030204 cardiovascular system & hematology, Kidney Function Tests, 03 medical and health sciences, 0302 clinical medicine, Sodium Potassium Chloride Symporter Inhibitors, Internal medicine, Acetazolamide/adverse effects, medicine, Natriuretic peptide, Humans, risk factors, Prospective Studies, Bumetanide, Aged, Heart Failure, Sodium Potassium Chloride Symporter Inhibitors/adverse effects, Dose-Response Relationship, Drug, Maintenance dose, business.industry, Middle Aged, Loop diuretic, Heart Failure/drug therapy, medicine.disease, Survival Analysis, Acetazolamide, Nephrology, Heart failure, Natriuresis/drug effects, Cardiology, Drug Therapy, Combination, Female, Diuretic, Cardiology and Cardiovascular Medicine, business, medicine.drug |
| الوصف: | Introduction Signs and symptoms of congestion are the predominant reason for hospital admission with acute heart failure (AHF). Diuretics are mainstay treatment, but their optimal type and dose regimen remains unclear. Hypothesis Acetazolamide in addition to loop diuretics increases natriuresis without further neurohumoral activation, potentially improving decongestion and outcomes in AHF. Methods This prospective, 2-center study included 34 AHF patients on loop diuretics with volume overload. All patients had a serum sodium concentration 50 and/or admission serum creatinine increased with >0.3 mg/dL compared to baseline. Patients were randomized towards acetazolamide 500 mg OD plus bumetanide 1-2 mg BID versus high-dose loop diuretics (bumetanide BID with bolus dose equal to oral maintenance dose). The primary end-point was natriuresis after 24h. Results Natriuresis after 24h was similar in the combinational treatment versus loop-diuretic only arm (264±126 versus 234±133 mmol, respectively; P-value=0.515). Loop diuretic efficiency, defined as natriuresis corrected for loop diuretic dose, was higher in the group receiving acetazolamide (84±46 versus 52±42 mmol/mg bumetanide, respectively; P-value=0.048; Figure). More patients in the combinational treatment arm had an increase in serum creatinine levels >0.3 mg/dL (P-value=0.046). NT-proBNP reduction and peak neurohumoral activation within 72h were comparable among treatment arms. Median time to all-cause mortality or heart failure readmission was 273 versus 803 days in the group receiving high-dose loop diuretic monotherapy versus acetazolamide with low-dose loop diuretics, which favoured the latter group but was not statistically significant (P-value=0.098). Conclusion Addition of acetazolamide increases the natriuretic response to loop diuretics with similar neurohumoral responses compared to an increase in loop diuretic dose in AHF at high risk for diuretic resistance. ClinicalTrials.gov identifier: NCT01973335. |
| تدمد: | 1879-0844 1388-9842 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::0faa8d2b75b1990e43b6f88489c02762 https://doi.org/10.1002/ejhf.1478 |
| حقوق: | OPEN |
| رقم الأكسشن: | edsair.doi.dedup.....0faa8d2b75b1990e43b6f88489c02762 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 18790844 13889842 |
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