Renal function and decongestion with acetazolamide in acute decompensated heart failure: the ADVOR trial
Key result
IV acetazolamide improves ADHF decongestion despite a ~114% higher rate of transient worsening renal function.
- P<.001
- n=519
Why the study?
Whether the beneficial decongestive effects of acetazolamide in acute decompensated heart failure are consistent across the entire range of renal function remained unclear.
Does intravenous acetazolamide improve decongestion and affect renal function in patients with acute decompensated heart failure across different baseline eGFR levels?
Population
519 patients with ADHF
Comparison
Intravenous acetazolamide vs matching placebo on top of intravenous loop diuretics
Design
Pre-specified analysis of a randomized trial
Follow-up
3 months
Authors
Discussion
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Member takes
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“suggest the use of acetazolamide as a reasonable adjunct to achieving more rapid decongestion”
“some limitations to the study include the lack of non-white participants, which may limit the generalizability of the results to other racial or ethnic groups”
Implication
Acetazolamide may aid decongestion across eGFR spectrum with amplified natriuresis at low eGFR; leaves open net benefit given higher WRF risk.
Key Points
- This analysis aims to determine the effects of acetazolamide on decongestion in acute decompensated heart failure across varying renal function levels.
- Randomized 519 patients with acute decompensated heart failure to intravenous acetazolamide or placebo alongside loop diuretics.
- Evaluated decongestion, diuresis, natriuresis, clinical outcomes, and renal function changes according to eGFR levels.
- Acetazolamide increased decongestion likelihood across all eGFR levels (P-interaction = .977).
- Higher natriuresis and diuresis rates observed with acetazolamide, particularly in low eGFR patients (P-interaction < .007).
- Increased incidence of worsening renal function with acetazolamide (40.5% vs. 18.9%; P < .001) without adverse clinical outcomes or mortality differences (P-interaction = .467).
Study Design
Type
RCT (n=519)
Structured PICO
Does intravenous acetazolamide improve decongestion and affect renal function in patients with acute decompensated heart failure across different baseline eGFR levels?
P
Population
519 patients with acute decompensated heart failure (ADHF)
I
Intervention
Intravenous acetazolamide added to intravenous loop diuretics
C
Comparator
Matching placebo added to intravenous loop diuretics
O
Outcome
Decongestion, diuresis, natriuresis, and clinical outcomes assessed according to baseline renal functionsurrogate
Main Result
Absolute Event Rate: 40.5% vs 18.9%
p-value: p=< .001
Acetazolamide improves decongestion in acute decompensated heart failure across all ranges of baseline renal function, and although it increases the risk of transient worsening renal function, this does not worsen clinical outcomes.
Cite This Study
Meekers et al. (2023) conducted an RCT in acute decompensated heart failure (ADHF) (n=519). intravenous acetazolamide vs. matching placebo was evaluated on worsening renal function (WRF; rise in creatinine ≥ 0.3 mg/dL) during the treatment period (p=< .001). Intravenous acetazolamide improved decongestion across all renal function ranges in ADHF, despite a higher incidence of transient worsening renal function (40.5% vs. 18.9%; P<0.001).