Diuretic, natriuretic, and chloride-regaining effects of oral acetazolamide as an add-on therapy for acute heart failure with volume overload: a single-center, prospective, randomized study

Introduction Decongestion is a therapeutic target in acute heart failure ( AHF). Acetazolamide is a diuretic that decreases proximal tubular sodium reabsorption, and may also reverse hypochloremia. Objectives We assessed the decongestive, natriuretic, and chloride-regaining effects as well as the renal safety profile of oral acetazolamide (250 mg) used as an add-on therapy in patients with AHF. Patients and methods This prospective, randomized study was conducted at the Institute of Heart Diseases in Wroclaw, Poland. It involved patients with AHF who were randomly assigned to receive either 250 mg of oral acetazolamide or standard care, and who underwent clinical and laboratory follow-up for 3 consecutive days since the beginning of the treatment and at discharge. Results The study population comprised 61 patients (71% men), of whom 31 (51%) were included in the acetazolamide group. The mean (SD) age of the patients was 68 (13) years. In comparison with the controls, the acetazolamide group demonstrated significantly higher cumulative diuresis after 48 and 72 hours since treatment implementation, negative fluid balance, weight loss after 48 hours of treatment, weight loss throughout the hospitalization, natriuresis, and serum chloride concentration. In terms of the renal safety profile, no increase in the creatinine concentration and urinary renal biomarker levels was noted. Conclusions Oral acetazolamide seems to be a valuable add-on therapy that helps achieve comprehensive decongestion in patients with AHF.