1091-142 - ACETAZOLAMIDE VERSUS THIAZIDES WITH LOOP DIURETICS IN ACUTE DECOMPENSATED HEART FAILURE

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Author Block: Allyson Chan, Huyentran Ngoc Tran, Loma Linda University Medical Center, Loma Linda, CA, USA
Background: Acetazolamide is a carbonic anhydrase inhibitor that reduces sodium absorption in the renal proximal tubule, and it has shown effectiveness in reducing volume overload when used in combination with loop diuretics compared to loop monotherapy for acute decompensated heart failure (ADHF). However, its efficacy and safety compared to the combination of thiazide and loop diuretics is unclear.
Methods: Single-centered, retrospective cohort study. Data collected for patients who received intravenous chlorothiazide, oral metolazone, or intravenous acetazolamide from September 2021 to August 2023. Inclusion criteria was patients aged 18 years or older with ADHF on loop and thiazide concomitantly or loop and acetazolamide concomitantly, and at least one clinical sign of fluid overload. Exclusion criteria was acetazolamide maintenance therapy or extracorporeal membrane oxygenation during hospitalization.
Results: Total 340 patients were divided into thiazide and loop (group 1, n=144), acetazolamide and loop (group 2, n=105), and all three diuretic classes (group 3, n=91). Participants were mostly white (48.2%) and male (61.5%). The primary outcome was average daily net urine output during diuretic therapy, and it was similar across all groups before and after adjusting for potential confounders such as weight, inotropes/vasoconstrictor use, and left ventricular ejection fraction (-1305.0 mL/day vs -1240.0 mL/day vs -1640.0 mL/day, p=0.223 before adjustment, p=0.790 and p=0.321 for group 1 vs 3 and group 2 vs 3 respectively after adjustment). The secondary outcomes were also non-significant, including length of hospital stay, 30-day and 90-day rehospitalization and mortality, and inpatient mortality. Fewer patients in group 2 developed acute kidney injury compared to groups 1 and 3 (18.1% vs 11.4% vs 23.1%, p=0.095).
Conclusion: There is no significant difference in average daily net urine output or safety outcomes among patients with ADHF on thiazide and loop, acetazolamide and loop, or all three classes of diuretics, even after adjusting for potential confounders. Further studies are warranted to determine optimal timing and doses of each diuretic when used in combination.