Adding acetazolamide to loop diuretics in patients with ADHF significantly increased natriuresis by day 3 (SMD 0.68; 95% CI 0.32-1.04; P=0.0002) and resulted in a more negative fluid balance.
Meta-Analysis
Does adding acetazolamide to loop diuretics improve natriuresis, fluid balance, and weight loss in patients with acute decompensated heart failure?
Adding acetazolamide to standard loop diuretic therapy significantly improves natriuresis and fluid balance in patients with acute decompensated heart failure without increasing adverse events.
Estimación del efecto: SMD 0.68 (95% CI 0.32, 1.04)
valor p: p=0.0002
Abstract Despite advances in heart failure management, treatment for acute decompensated heart failure (ADHF) remains largely unchanged. Loop diuretics are the mainstay for fluid overload due to their rapid onset and efficacy. However, insufficient decongestion, poor diuretic response, and resistance lead to suboptimal symptom relief, prolonged hospital stays, and increased mortality. Evidence suggests that adding acetazolamide to loop diuretics improves decongestion without escalating diuretic doses. However, limited data regarding its efficacy and safety preclude its incorporation in clinical guidelines. Objective: To determine the efficacy and safety of acetazolamide combined with loop diuretics in patients with ADHF. Methods: A systematic review was conducted to assess studies comparing loop diuretics alone versus with acetazolamide in ADHF patients. Eligible studies included prospective and retrospective observational studies, and randomized controlled trials. The primary outcomes evaluated were natriuresis, fluid balance, and weight loss. Secondary outcomes included rate of rehospitalization, all-cause mortality, and presence of adverse events. This review followed PRISMA-P guidelines. Data were analyzed using Review Manager Version 5.4.1. Statistical methods adhered to the Cochrane Handbook for Systematic Reviews of Interventions. Results: Six studies were selected from the initial 681 studies identified through the literature search. Analyses revealed acetazolamide supplementation significantly increased natriuresis by day 3 SMD 0.68, 95% CI (0.32, 1.04), P=0.0002 and resulted in a more negative fluid balance SMD -0.77, 95% CI (-1.23, -0.32) P=0.0008. Weight loss SMD 0.17, 95% CI, (-0.19, 0.53) P=0.36 was also higher in the acetazolamide group, but the effect was not statistically significant. In terms of safety, the all-cause mortality, rate of rehospitalization, and presence of adverse events were similar between the two groups. Conclusion: This study provides significant evidence regarding the clinical benefit of adding acetazolamide to standard loop diuretic therapy in decongesting patients with ADHF.
Interior et al. (Sat,) conducted a meta-analysis in Acute decompensated heart failure (ADHF). Acetazolamide vs. Loop diuretics alone was evaluated on Natriuresis by day 3 (SMD 0.68, 95% CI 0.32, 1.04, p=0.0002). Adding acetazolamide to loop diuretics in patients with ADHF significantly increased natriuresis by day 3 (SMD 0.68; 95% CI 0.32-1.04; P=0.0002) and resulted in a more negative fluid balance.