Department of Cardiology, Ziekenhuis Oost-Limburg A.V, Genk, Belgium.
Hasselt University, Diepenbeek/Hasselt, Belgium.
Eur J Heart Fail. 2023 Aug;25(8):1310-1319. doi: 10.1002/ejhf.2863. Epub 2023 May 10.
Acetazolamide, an inhibitor of proximal tubular sodium reabsorption, leads to more effective decongestion in acute heart failure (AHF). It is unknown whether acetazolamide alters serum sodium and potassium levels on top of loop diuretics and if baseline values modify the treatment effect of acetazolamide.
This is a pre-specified sub-analysis of the ADVOR trial that randomized 519 patients with AHF and volume overload in a 1:1 ratio to intravenous acetazolamide or matching placebo on top of standardized intravenous loop diuretics. Mean potassium and sodium levels at randomization were 4.2 ± 0.6 and 139 ± 4 mmol/L in the acetazolamide arm versus 4.2 ± 0.6 and 140 ± 4 mmol/L in the placebo arm. Hypokalaemia (<3.5 mmol/L) on admission was present in 44 (9%) patients and hyponatraemia (≤135 mmol/L) in 82 (16%) patients. After 3 days of treatment, 44 (17%) patients in the acetazolamide arm and 35 (14%) patients in the placebo arm developed hyponatraemia (p = 0.255). Patients randomized to acetazolamide demonstrated a slight decrease in mean potassium levels during decongestion, which was non-significant over time (p = 0.053) and had no significant impact on hypokalaemia incidence (p = 0.061). Severe hypokalaemia (<3.0 mmol/L) occurred in only 7 (1%) patients, similarly distributed between the two treatment arms (p = 0.676). Randomization towards acetazolamide improved decongestive response irrespective of baseline serum sodium and potassium levels.
Acetazolamide on top of standardized loop diuretic therapy does not lead to clinically important hypokalaemia or hyponatraemia and improves decongestion over the entire range of baseline serum potassium and sodium levels.
乙酰唑胺是一种近端肾小管钠重吸收抑制剂，可使急性心力衰竭（AHF）患者更有效地消肿。目前尚不清楚乙酰唑胺是否会在袢利尿剂的基础上改变血清钠和钾水平，以及基线值是否会改变乙酰唑胺的治疗效果。
这是 ADVOR 试验的一项预先指定的亚分析，该试验将 519 例 AHF 合并容量超负荷患者以 1:1 的比例随机分为静脉乙酰唑胺或匹配安慰剂组，在标准静脉袢利尿剂的基础上加用。乙酰唑胺组和安慰剂组随机分组时的平均血钾和血钠水平分别为 4.2±0.6 和 139±4mmol/L，4.2±0.6 和 140±4mmol/L。入院时低钾血症（<3.5mmol/L）见于 44 例（9%）患者，低钠血症（≤135mmol/L）见于 82 例（16%）患者。治疗 3 天后，乙酰唑胺组 44 例（17%）患者和安慰剂组 35 例（14%）患者发生低钠血症（p=0.255）。接受乙酰唑胺治疗的患者在消肿过程中血钾平均水平略有下降，但随时间推移无显著差异（p=0.053），对低钾血症发生率无显著影响（p=0.061）。仅 7 例（1%）患者发生严重低钾血症（<3.0mmol/L），两组间分布相似（p=0.676）。无论基线血清钠和钾水平如何，随机给予乙酰唑胺均可改善消肿反应。
在标准袢利尿剂治疗的基础上加用乙酰唑胺不会导致临床显著的低钾血症或低钠血症，并在整个基线血清钾和钠水平范围内改善消肿。
