Evidence map›Paper›PMID 34575318›Full record

ArticleJournal of clinical medicine2021

Effects of Metolazone Administration on Congestion, Diuretic Response and Renal Function in Patients with Advanced Heart Failure.

Alberto Palazzuoli, Gaetano Ruocco, Paolo Severino, Luigi Gennari, Filippo Pirrotta, Andrea Stefanini, Francesco Tramonte, Mauro Feola, Massimo Mancone, Francesco Fedele

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of clinical medicine, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.

0numbers the graph read from it
0cells of the map it votes in
13citing papers in PubMed
2.4field-weighted citation impact, top 10% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

13 citing papers in PubMed, 20 citations in OpenAlex.

  1. Diuretics in Cardiovascular Disease: For How Long and at What Dose?Journal of cardiovascular development and disease · 2026
    Review
  2. Article
  3. Review
  4. Article
  5. Article
  6. Review
  7. Proximal versus distal diuretics in congestive heart failure.Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2024
    Review
  8. Review
  9. Review
  10. One-pot Synthesis of 2,3-disubstituted-4(3Current organic synthesis · 2024
    Article
  11. Review
  12. Article
  13. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 3 institutions in 1 country.

Alberto PalazzuoliCardiovascular Diseases Unit, Department of Medical Sciences, Le Scotte Hospital, 53100 Siena, Italy.ORCID 0000-0002-6235-984X
Gaetano RuoccoCardiology Unit, Riuniti of Valdichiana Hospital, USL SUD-EST Toscana, Montepulciano, 53045 Siena, Italy.
Paolo SeverinoDepartment of Clinical, Internal Anesthesiology and Cardiovascular Sciences, University La Sapienza, 00185 Rome, Italy.ORCID 0000-0001-6211-4482
Luigi GennariCardiovascular Diseases Unit, Department of Medical Sciences, Le Scotte Hospital, 53100 Siena, Italy.
Filippo PirrottaCardiovascular Diseases Unit, Department of Medical Sciences, Le Scotte Hospital, 53100 Siena, Italy.
Andrea StefaniniCardiovascular Diseases Unit, Department of Medical Sciences, Le Scotte Hospital, 53100 Siena, Italy.
Francesco TramonteCardiovascular Diseases Unit, Department of Medical Sciences, Le Scotte Hospital, 53100 Siena, Italy.ORCID 0000-0002-9296-0281
Mauro FeolaCardiology Unit, Regina Montis Regalis Hospital, 12084 Mondovì, Italy.
Massimo ManconeDepartment of Clinical, Internal Anesthesiology and Cardiovascular Sciences, University La Sapienza, 00185 Rome, Italy.
Francesco FedeleDepartment of Clinical, Internal Anesthesiology and Cardiovascular Sciences, University La Sapienza, 00185 Rome, Italy.
Ospedale Santa Maria alle Scotte · ITSapienza University of Rome · ITAzienda Usl Toscana Centro · IT

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAdvanced heart failure (HF) is a condition often requiring elevated doses of loop diuretics. Therefore, these patients often experience poor diuretic response. Both conditions have a detrimental impact on prognosis and hospitalization.

aimsThis retrospective, multicenter study evaluates the effect of the addition of oral metolazone on diuretic response (DR), clinical congestion, NTproBNP values, and renal function over hospitalization phase. Follow-up analysis for a 6-month follow-up period was performed.

methodsWe enrolled 132 patients with acute decompensated heart failure (ADHF) in advanced NYHA class with reduced ejection fraction (EF < 40%) taking a mean furosemide amount of 250 ± 120 mg/day. Sixty-five patients received traditional loop diuretic treatment plus metolazone (Group M). The mean dose ranged from 7.5 to 15 mg for one week. Sixty-seven patients continued the furosemide (Group F). Congestion score was evaluated according to the ESC recommendations. DR was assessed by the formula diuresis/40 mg of furosemide.

resultsPatients in Group M and patients in Group F showed a similar prevalence of baseline clinical congestion (3.1 ± 0.7 in Group F vs. 3 ± 0.8 in Group M) and chronic kidney disease (CKD) (51% in Group M vs. 57% in Group F;

conclusionsMetolazone administration could be helpful in patients taking an elevated loop diuretics dose. Use of thiazide therapy is associated with better decongestion and DR. Current findings could suggest positive insights due to the reduced amount of loop diuretics in patients with advanced HF.

Indexed as

congestiondiureticsheart failuremanagement

Identifiers

PMID34575318
PMCPMC8465476
OpenAlexW3200605665

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.