Diuresis Efficacy in Ambulatory Congested Heart Failure Patients: Intrapatient Comparison of 3 Diuretic Regimens (DEA-HF).

Autor:	Abbo AR; Heart Failure Unit, Department of Cardiology and the Rambam Health Care Campus, Haifa, Israel., Gruber A; Heart Failure Unit, Department of Cardiology and the Rambam Health Care Campus, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel., Volis I; Heart Failure Unit, Department of Cardiology and the Rambam Health Care Campus, Haifa, Israel., Aronson D; Heart Failure Unit, Department of Cardiology and the Rambam Health Care Campus, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel., Girerd N; Université de Lorraine, INSERM, Centre d'Investigations Cliniques-Plurithématique 1433, CHRU Nancy, and INSERM U1116, CHRU, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France., Lund Kristensen S; Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark., Zukermann R; Heart Failure Unit, Department of Cardiology and the Rambam Health Care Campus, Haifa, Israel., Alberkant N; Heart Failure Unit, Department of Cardiology and the Rambam Health Care Campus, Haifa, Israel., Sitnitsky E; Heart Failure Unit, Department of Cardiology and the Rambam Health Care Campus, Haifa, Israel., Kruger A; Heart Failure Unit, Department of Cardiology and the Rambam Health Care Campus, Haifa, Israel., Khasis P; Heart Failure Unit, Department of Cardiology and the Rambam Health Care Campus, Haifa, Israel., Bravo E; Heart Failure Unit, Department of Cardiology and the Rambam Health Care Campus, Haifa, Israel., Elad B; Heart Failure Unit, Department of Cardiology and the Rambam Health Care Campus, Haifa, Israel., Helmer Levin L; Heart Failure Unit, Department of Cardiology and the Rambam Health Care Campus, Haifa, Israel., Caspi O; Heart Failure Unit, Department of Cardiology and the Rambam Health Care Campus, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel; Clinical Research Institute at Rambam (CRIR), Haifa, Israel. Electronic address: o_caspi@rmc.gov.il.
Jazyk:	angličtina
Zdroj:	JACC. Heart failure [JACC Heart Fail] 2024 Aug; Vol. 12 (8), pp. 1396-1405. Date of Electronic Publication: 2024 May 11.
DOI:	10.1016/j.jchf.2024.04.014
Abstrakt:	Background: Limited evidence exists regarding efficacy and safety of diuretic regimens in ambulatory, congestion-refractory, chronic heart failure (CHF) patients. Objectives: The authors sought to compare the potency and safety of commonly used diuretic regimens in CHF patients. Methods: A prospective, randomized, open-label, crossover study conducted in NYHA functional class II to IV CHF patients, treated in an ambulatory day-care unit. Each patient received 3 different diuretic regimens: intravenous (IV) furosemide 250 mg; IV furosemide 250 mg plus oral metolazone 5 mg; and IV furosemide 250 mg plus IV acetazolamide 500 mg. Treatments were administered once a week, in 1 of 6 randomized sequences. The primary endpoint was total sodium excretion, and the secondary was total urinary volume excreted, both measured for 6 hours post-treatment initiation. Results: A total of 42 patients were recruited. Administration of furosemide plus metolazone resulted in the highest weight of sodium excreted, 4,691 mg (95% CI: 4,153-5,229 mg) compared with furosemide alone, 3,835 mg (95% CI: 3,279-4,392 mg; P = 0.015) and to furosemide plus acetazolamide 3,584 mg (95% CI: 3,020-4,148 mg; P = 0.001). Furosemide plus metolazone resulted in 1.84 L of urine (95% CI: 1.63-2.05 L), compared with 1.58 L (95% CI: 1.37-1.8); P = 0.039 collected following administration of furosemide plus acetazolamide and 1.71 L (95% CI: 1.49-1.93 L) following furosemide alone. The incidence of worsening renal function was significantly higher when adding metolazone (39%) to furosemide compared with furosemide alone (16%) and to furosemide plus acetazolamide (2.6%) (P < 0.001). Conclusions: In ambulatory CHF patients, furosemide plus metolazone resulted in a significantly higher natriuresis compared with IV furosemide alone or furosemide plus acetazolamide. Competing Interests: Funding Support and Author Disclosures Dr Abbo has been a consultant for Edwards Life Sciences; and has received speaker honoraria from Boehringer Ingelheim. Dr Kristensen has been a consultant for Bayer; and has received speaker honoraria from AstraZeneca. Dr Caspi has received speaker honoraria from AstraZeneca, Novo Nordisk, and Pfizer; and has received consultancy honoraria from Vectorious medical technologies. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. (Copyright © 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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