JACC Heart Fail

Diuretics for congestion-refractory HF: Three regimens go head-to-head

July 16, 2024

Among ambulatory congestive heart failure (CHF) patients, furosemide plus metolazone resulted in significantly higher natriuresis compared with IV furosemide alone or furosemide plus acetazolamide.

• In the Heart Failure Diuresis Efficacy Comparison (DEA-HF) study, 42 patients received 3 different diuretic regimens that were administered once a week in randomized sequences: IV furosemide 250 mg; IV furosemide 250 mg plus oral metolazone 5 mg; and IV furosemide 250 mg plus IV acetazolamide 500 mg. Total sodium excretion (primary endpoint) and total urinary volume excreted (secondary endpoint) were measured for 6 hours post-treatment initiation.
• Furosemide plus metolazone resulted in the greatest sodium excretion (4,691 mg) compared with furosemide alone (3,835 mg; P=0.015) and to furosemide plus acetazolamide (3,584 mg; P=0.001). Furosemide plus metolazone resulted in 1.84 L of urine compared with 1.58 L with furosemide plus acetazolamide and 1.71 L following furosemide alone.
• However, the incidence of worsening renal function was significantly higher when adding metolazone (39%) to furosemide vs. furosemide alone (16%) and furosemide plus acetazolamide (2.6%).

Source:

Abbo AR, et al. (2024, May 11). JACC Heart Fail. Diuresis Efficacy in Ambulatory Congested Heart Failure Patients: Intrapatient Comparison of 3 Diuretic Regimens (DEA-HF). https://pubmed.ncbi.nlm.nih.gov/38739124/