AIMS To investigate the effects of acetazolamide on natriuresis, decongestion, kidney function and neurohumoral activation in acute heart failure (AHF). METHODS AND RESULTS This prospective, two-centre study included 34 AHF patients on loop diuretics with volume overload. All had a serum sodium concentration < 135 mmol/L and/or serum urea/creatinine ratio > 50 and/or an admission serum creatinine increase of > 0.3 mg/dL compared to baseline. Patients were randomised towards acetazolamide 250-500 mg daily plus bumetanide 1-2 mg bid vs. high-dose loop diuretics (bumetanide bid with daily dose twice the oral maintenance dose). The primary endpoint was natriuresis after 24 h. Natriuresis after 24 h was similar in the combinational treatment vs. loop diuretic only arm (264 ± 126 vs. 234 ± 133 mmol; P = 0.515). Loop diuretic efficiency, defined as natriuresis corrected for loop diuretic dose, was higher in the group receiving acetazolamide (84 ± 46 vs. 52 ± 42 mmol/mg bumetanide; P = 0.048). More patients in the combinational treatment arm had an increase in serum creatinine levels > 0.3 mg/dL (P = 0.046). N-terminal pro-B-type natriuretic peptide reduction and peak neurohumoral activation within 72 h were comparable among treatment arms. There was a non-significant trend towards lower all-cause mortality or heart failure readmissions in the group receiving acetazolamide with low-dose loop diuretics vs. high-dose loop diuretic monotherapy (P = 0.098). CONCLUSION Addition of acetazolamide increases the natriuretic response to loop diuretics compared to an increase in loop diuretic dose in AHF at high risk for diuretic resistance. TRIAL REGISTRATION ClinicalTrials.gov NCT01973335.

中文翻译：

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乙酰唑胺可增加充血性心力衰竭中利尿钠的利尿剂高风险。

目的探讨乙酰唑胺对急性心力衰竭（AHF）患者排钠，充血，肾功能和神经体液激活的影响。方法和结果这项前瞻性，两中心研究纳入了34名AHF环行利尿剂伴容量超负荷的患者。与基线相比，所有患者的血钠浓度<135 mmol / L和/或血尿素/肌酐之比> 50，和/或入院时血肌酐增加> 0.3 mg / dL。患者随机分为乙酰唑胺每日250-500 mg加布美他尼1-2 mg每日两次与大剂量loop利尿剂（布美他尼每日两次，口服维持剂量两次）。主要终点为24小时后排尿。与仅使用loop利尿剂组相比，联合治疗24小时后的利尿作用相似（264±126 vs. 234±133 mmol； P = 0.515）。利尿剂循环效率 在接受乙酰唑胺治疗的组中，定义为利尿剂校正为loop利尿剂剂量的尿毒症患者较高（84±46 vs. 52±42 mmol / mg布美他尼； P = 0.048）。联合治疗组中更多的患者血清肌酐水平升高> 0.3 mg / dL（P = 0.046）。在治疗组中，N端前B型利尿钠肽减少和72h内的峰值神经体液激活相当。低剂量loop利尿剂组与高剂量tics利尿剂单药治疗组相比，接受乙酰唑胺治疗组的全因死亡率或心力衰竭再入院率降低的趋势不显着（P = 0.098）。结论与在高利尿剂耐药风险的AHF中增加利尿剂剂量相比，添加乙酰唑胺可增加利尿剂对利尿剂的反应。试验注册临床试验。