PDF(Pubmed)
Abstract：
Objectives: This real-life study aimed to evaluate the safety of acetazolamide (ACZ), a carbonic anhydrase inhibitor with diuretic effects. ACZ has recently been proven to improve decongestion in the context of patients hospitalized for acute heart failure (HF). However, data in terms of safety are lacking. Methods: We conducted a monocentric observational prospective study from November 2023 to February 2024 in a 12-bed cardiology department, recording adverse events (hypotension, severe metabolic acidosis, severe hypokalemia and renal events) during in-hospital HF treatment. All patients hospitalized for acute HF during the study period treated with ACZ (500 mg IV daily for 3 days) on top of IV furosemide (n = 28, 48.3%) were compared with patients who have been treated with IV furosemide alone (n = 30, 51.7%). Results: The patients treated with ACZ were younger than those without (median age 78 (range 67-86) vs. 85 (79-90) years, respectively, p = 0.01) and had less frequent chronic kidney disease (median estimated glomerular fraction rate (60 (35-65) vs. 38 (26-63) mL/min, p = 0.02). As concerned adverse events during HF treatment, there were no differences in the occurrences of hypotension (three patients [10.7%] in the ACZ group vs. four [13.3%], p = 0.8), renal events (four patients [14.3%] in the ACZ group vs. five [16.7%], p = 1) and severe hypokalemia (two [7.1%] in the ACZ group vs. three [10%], p = 1). No severe metabolic acidosis occurred in either group. Conclusions: Although the clinical characteristics differed at baseline, with younger age and better renal function in patients receiving ACZ, the tolerance profile did not significantly differ from patients receiving furosemide alone. Additional observational data are needed to further assess the safety of ACZ-furosemide combination in the in-hospital management of HF, especially in older, frail populations.
摘要：
目的：这项现实生活中的研究旨在评估乙酰唑胺（ACZ）的安全性，一种具有利尿作用的碳酸酐酶抑制剂。ACZ最近被证明可以改善因急性心力衰竭（HF）住院的患者的充血。然而,缺乏安全性方面的数据。方法：我们从2023年11月至2024年2月在12张病床的心脏科进行了一项单中心观察性前瞻性研究，记录不良事件(低血压，严重的代谢性酸中毒，严重的低钾血症和肾脏事件）在院内HF治疗期间。在研究期间，所有因急性HF住院的患者在IV呋塞米（n=28，48.3％）的基础上接受ACZ（每天500mg，持续3天）治疗（n=30，51.7％）。结果：接受ACZ治疗的患者比没有接受ACZ治疗的患者年轻（中位年龄78（范围67-86）与85（79-90）年，分别,p=0.01），并且患有慢性肾脏疾病的频率较低（估计的肾小球分数中位数（60（35-65）与38(26-63)mL/min,p=0.02)。关于HF治疗期间的不良事件，低血压的发生率没有差异（ACZ组的3例患者[10.7％]与四个[13.3%]，p=0.8),肾脏事件（ACZ组4例[14.3%]与五[16.7%]，p=1）和严重低钾血症（ACZ组的两个[7.1％]与三个[10%]，p=1)。两组均未发生严重代谢性酸中毒。结论：尽管基线时的临床特征不同，接受ACZ的患者年龄更小，肾功能更好，与单独接受呋塞米的患者相比,耐受性没有显著差异.需要更多的观察数据来进一步评估ACZ-呋塞米组合在HF住院管理中的安全性。尤其是在老年人中，脆弱的人口。
