Trullàs Joan Carles, Morales-Rull José Luís, Casado Jesús, Carrera-Izquierdo Margarita, Sánchez-Marteles Marta, Conde-Martel Alicia, Dávila-Ramos Melitón Francisco, Llácer Pau, Salamanca-Bautista Prado, Chivite David, Jordana-Comajuncosa Rosa, Villalonga Maria, Páez-Rubio María Inmaculada, Manzano Luís, Formiga Francesc
Internal Medicine Department, Hospital d'Olot i Comarcal de la Garrotxa, Girona, Spain.
Tissue Repair and Regeneration Laboratory (TR2Lab), Institut de Recerca i Innovació en Ciències de la Vida i de la Salut a la Catalunya Central (IrisCC), Barcelona, Spain.
Eur J Heart Fail. 2023 Oct;25(10):1784-1793. doi: 10.1002/ejhf.2988. Epub 2023 Aug 16.
In patients with acute heart failure (AHF), the addition of hydrochlorothiazide (HCTZ) to furosemide improved diuretic response in the CLOROTIC trial. This work aimed to evaluate if these effects differ across the estimated glomerular filtration rate (eGFR) spectrum.
This post-hoc analysis of the CLOROTIC trial analysed 230 patients with AHF and explored the influence of eGFR on primary and secondary endpoints. The median eGFR was 43 ml/min/1.73 m (range 14-109) and 23% had eGFR ≥60 ml/min/1.73 m (group 1), 24% from 45 to 59 ml/min/1.73 m (group 2), and 53% <45 ml/min/1.73 m (group 3). Patients treated with HCTZ had greatest weight loss at 72 h in all three groups, but patients in group 1 had a significantly greater response (-2.1 kg [-3.0 to 0.5]), compared to patients in groups 2 (-1.3 kg [-2.3 to 0.2]) and 3 (-0.1 kg [-1.3 to 0.4]) (p-value for interaction = 0.246). At 96 h, the differences in weight were -1.8 kg (-3.0 to -0.3), -1.4 kg (-2.6 to 0.3), and -0.5 kg (-1.3 to -0.1) in groups 1, 2, and 3, respectively (p-value for interaction = 0.256). There were no significant differences observed with the addition of HCTZ in terms of diuretic response, mortality or rehospitalizations, or safety endpoints (impaired renal function, hyponatraemia, and hypokalaemia) among the three eGFR groups (all p-values for interaction were no significant).
The addition of eGFR-adjusted doses of oral HCTZ to loop diuretics in patients with AHF improved diuretic response across the eGFR spectrum.
ClinicalTrials.gov: NCT01647932; EudraCT number: 2013-001852-36.
在急性心力衰竭（AHF）患者中，氯噻嗪试验显示在呋塞米基础上加用氢氯噻嗪（HCTZ）可改善利尿反应。本研究旨在评估这些效应在估计肾小球滤过率（eGFR）范围内是否存在差异。
对氯噻嗪试验进行的这项事后分析纳入了230例AHF患者，探讨eGFR对主要和次要终点的影响。eGFR中位数为43 ml/min/1.73m²（范围14 - 109），23%的患者eGFR≥60 ml/min/1.73m²（第1组），24%的患者eGFR为45至59 ml/min/1.73m²（第2组），53%的患者eGFR<45 ml/min/1.73m²（第3组）。在所有三组中，接受HCTZ治疗的患者在72小时时体重减轻最多，但第1组患者的反应明显更大（-2.1kg [-3.0至0.5]），与第2组（-1.3kg [-2.3至0.2]）和第3组（-0.1kg [-1.3至0.4]）患者相比（交互作用p值 = 0.246）。在96小时时，第1、2和3组的体重差异分别为-1.8kg（-3.0至-0.3）、-1.4kg（-2.6至0.3）和-0.5kg（-1.3至-0.1）（交互作用p值 = 0.256）。在三组eGFR患者中，加用HCTZ在利尿反应、死亡率或再住院率以及安全性终点（肾功能损害、低钠血症和低钾血症）方面均未观察到显著差异（所有交互作用p值均无统计学意义）。
在AHF患者中，在袢利尿剂基础上加用根据eGFR调整剂量的口服HCTZ可在整个eGFR范围内改善利尿反应。
ClinicalTrials.gov：NCT01647932；EudraCT编号：2013 - 001852 - 36。
