Abstract：
Acetazolamide, an inhibitor of proximal tubular sodium reabsorption, leads to more effective decongestion in acute heart failure (AHF). It is unknown whether acetazolamide alters serum sodium and potassium levels on top of loop diuretics and if baseline values modify the treatment effect of acetazolamide.
This is a pre-specified sub-analysis of the ADVOR trial that randomized 519 patients with AHF and volume overload in a 1:1 ratio to intravenous acetazolamide or matching placebo on top of standardized intravenous loop diuretics. Mean potassium and sodium levels at randomization were 4.2 ± 0.6 and 139 ± 4 mmol/L in the acetazolamide arm versus 4.2 ± 0.6 and 140 ± 4 mmol/L in the placebo arm. Hypokalaemia (<3.5 mmol/L) on admission was present in 44 (9%) patients and hyponatraemia (≤135 mmol/L) in 82 (16%) patients. After 3 days of treatment, 44 (17%) patients in the acetazolamide arm and 35 (14%) patients in the placebo arm developed hyponatraemia (p = 0.255). Patients randomized to acetazolamide demonstrated a slight decrease in mean potassium levels during decongestion, which was non-significant over time (p = 0.053) and had no significant impact on hypokalaemia incidence (p = 0.061). Severe hypokalaemia (<3.0 mmol/L) occurred in only 7 (1%) patients, similarly distributed between the two treatment arms (p = 0.676). Randomization towards acetazolamide improved decongestive response irrespective of baseline serum sodium and potassium levels.
Acetazolamide on top of standardized loop diuretic therapy does not lead to clinically important hypokalaemia or hyponatraemia and improves decongestion over the entire range of baseline serum potassium and sodium levels.
This is a pre-specified sub-analysis of the ADVOR trial that randomized 519 patients with AHF and volume overload in a 1:1 ratio to intravenous acetazolamide or matching placebo on top of standardized intravenous loop diuretics. Mean potassium and sodium levels at randomization were 4.2 ± 0.6 and 139 ± 4 mmol/L in the acetazolamide arm versus 4.2 ± 0.6 and 140 ± 4 mmol/L in the placebo arm. Hypokalaemia (<3.5 mmol/L) on admission was present in 44 (9%) patients and hyponatraemia (≤135 mmol/L) in 82 (16%) patients. After 3 days of treatment, 44 (17%) patients in the acetazolamide arm and 35 (14%) patients in the placebo arm developed hyponatraemia (p = 0.255). Patients randomized to acetazolamide demonstrated a slight decrease in mean potassium levels during decongestion, which was non-significant over time (p = 0.053) and had no significant impact on hypokalaemia incidence (p = 0.061). Severe hypokalaemia (<3.0 mmol/L) occurred in only 7 (1%) patients, similarly distributed between the two treatment arms (p = 0.676). Randomization towards acetazolamide improved decongestive response irrespective of baseline serum sodium and potassium levels.
Acetazolamide on top of standardized loop diuretic therapy does not lead to clinically important hypokalaemia or hyponatraemia and improves decongestion over the entire range of baseline serum potassium and sodium levels.
摘要：
目的：乙酰唑胺，近端肾小管钠重吸收的抑制剂，在急性心力衰竭（AHF）中导致更有效的充血。尚不清楚乙酰唑胺是否会改变loop利尿剂顶部的血清钠和钾水平，以及基线值是否会改变乙酰唑胺的治疗效果。
结果：这是对ADVOR试验的预设子分析，该试验将519例AHF和容量超负荷患者以1：1的比例随机分配给静脉注射乙酰唑胺或匹配的安慰剂，再加上标准化的静脉环路利尿剂。随机分组时，乙酰唑胺组的平均钾和钠水平分别为4.2±0.6和139±4mmol/L，而安慰剂组为4.2±0.6和140±4mmol/L。44例（9％）患者入院时出现低钾血症（<3.5mmol/L），82例（16％）患者出现低钠血症（≤135mmol/L）。治疗3天后，乙酰唑胺组的44例（17％）患者和安慰剂组的35例（14％）患者出现低钠血症（p=0.255）。随机接受乙酰唑胺治疗的患者在充血期间平均钾水平略有下降，随着时间的推移无统计学意义(p=0.053),对低钾血症发生率无显著影响(p=0.061).严重低钾血症（<3.0mmol/L）仅发生在7例（1%）患者中，相似地分布在两个治疗臂之间(p=0.676)。与基线血清钠和钾水平无关，对乙酰唑胺的随机化可改善充血反应。
结论：乙酰唑胺在标准循环利尿剂治疗基础上不会导致临床上重要的低钾血症或低钠血症，并在整个基线血清钾和钠水平范围内改善充血。本文受版权保护。保留所有权利。
结果：这是对ADVOR试验的预设子分析，该试验将519例AHF和容量超负荷患者以1：1的比例随机分配给静脉注射乙酰唑胺或匹配的安慰剂，再加上标准化的静脉环路利尿剂。随机分组时，乙酰唑胺组的平均钾和钠水平分别为4.2±0.6和139±4mmol/L，而安慰剂组为4.2±0.6和140±4mmol/L。44例（9％）患者入院时出现低钾血症（<3.5mmol/L），82例（16％）患者出现低钠血症（≤135mmol/L）。治疗3天后，乙酰唑胺组的44例（17％）患者和安慰剂组的35例（14％）患者出现低钠血症（p=0.255）。随机接受乙酰唑胺治疗的患者在充血期间平均钾水平略有下降，随着时间的推移无统计学意义(p=0.053),对低钾血症发生率无显著影响(p=0.061).严重低钾血症（<3.0mmol/L）仅发生在7例（1%）患者中，相似地分布在两个治疗臂之间(p=0.676)。与基线血清钠和钾水平无关，对乙酰唑胺的随机化可改善充血反应。
结论：乙酰唑胺在标准循环利尿剂治疗基础上不会导致临床上重要的低钾血症或低钠血症，并在整个基线血清钾和钠水平范围内改善充血。本文受版权保护。保留所有权利。
