Trial reportClinical research in cardiology : official journal of the German Cardiac Society2026
ADA-HF: acetazolamide as a chloride sparing diuretic in patients admitted to hospital with heart failure.
Trial report in Clinical research in cardiology : official journal of the German Cardiac Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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13 authors.
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Abstract
backgroundWe assessed whether oral acetazolamide (ACZ) increases diuresis and reduces chloride loss when given alongside high-dose intravenous (IV) furosemide in patients admitted to hospital with HF. METHODS AND
resultsADA-HF was a single-centre, open-label, randomised controlled trial. Patients were randomised to ACZ 250 mg twice daily plus high-dose (240 mg per day) IV furosemide infusion (standard of care (SoC)) versus SoC alone for 4 days. The co-primary endpoints were (1) daily net fluid loss between baseline and day 4 and (2) change in serum chloride level from baseline to day 4. A total of 46 patients (median age, 76; 65% male; median N-terminal pro-B-type natriuretic peptide, 4097 ng/L) from a screened population of 207 were randomised (23 to ACZ, 23 to SoC). The median daily net fluid loss was 1073 mL (1st-3rd quartile range 682-1419 mL) in the ACZ arm vs. 1029 mL (201-1432 mL) in the SoC arm (P = 0.51). There was no change in serum chloride concentration in the ACZ arm, whereas chloride fell by 7 (2-10) mmol/L in the SoC arm (P < 0.001). The number of adverse and serious adverse events ((S)AE) was numerically greater in the ACZ arm (51 events in 16 patients vs. 29 events in 10 patients, P = 0.24). Overall, 8 patients (30%) experienced (S)AEs possibly related to ACZ, and two of whom withdrew from the trial.
conclusionsAcetazolamide has a significant "chloride-sparing" effect in patients given high-dose IV furosemide. However, ACZ did not significantly increase diuresis, and side effects from oral ACZ were frequent.
trial registrationISRCTN13060336; 9/2/2023.
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