Acetazolamide as a chloride sparing diuretic in patients with decompensated heart failure
Research type
Research Study
Full title
Acetazolamide as a chloride sparing Diuretic in patients Admitted with Heart Failure: a pilot and exploratory study (ADA-HF)
IRAS ID
1005718
Contact name
Joe Cuthbert
Contact email
Sponsor organisation
Hull Univeristy Teaching Hospitals
Eudract number
2022-001566-34
ISRCTN Number
ISRCTN13060336
Research summary
Background
Heart failure(HF) is a chronic condition characterised by fluid retention - "venous congestion" - due to impaired heart pump function causing breathlessness and limb swelling. Uncontrolled fluid retention due to HF is a common reason for hospital admission. Treatment of venous congestion is with diuretics that increase the amount of salt - predominantly sodium and chloride - passed in the urine. This, in turn, increases the amount of water excreted and so a patient loses fluid - diuresis.The problem
Resistance to diuretics is common and adequate diuresis may take many days. Furthermore, commonly used diuretics may cause low chloride levels (hypochloraemia) in the blood which is linked to a poor prognosis. At present there are few treatments available for diuretic resistance or hypochloraemia.The solution
Acetazolamide is a drug that may cause diuresis and increase serum chloride levels. It works on a different portion of the kidney to more commonly used diuretics and may therefore have an additive value that can either overcome diuretic resistance or speed up diuresis, thus shortening hospital stays. Increasing serum chloride may reduce the risk of developing hypochloraemia or treat those with hypochloraemia which may improve outcome. The effect of acetazolamide on diuresis or chloride levels in patients with HF is unknown but potentially beneficial.To test the diuretic affect of acetazolamide we will randomise up to 50 patients admitted with HF at a single tertiary cardiology centre in Yorkshire to either acetazolamide plus standard diuretic treatment or standard care alone over a four day period. We will measure urine volume, weight loss, patient symptoms, clinical and echocardiagraphic signs of congestion (non-invasive ultrasound tests) and urine and blood salt levels including kidney function on a daily basis. Patients will continue to be seen by the on-call cardiology team and will continue under their care once the trial is over.
REC name
East Midlands - Nottingham 2 Research Ethics Committee
REC reference
22/EM/0264
Date of REC Opinion
2 Feb 2023
REC opinion
Further Information Favourable Opinion