Early acute declines in eGFR among ADHF patients treated with thiazide plus loop diuretics were not associated with increased mortality risk (HR 0.96; 95% CI 0.47-1.97 per 30% decline at 2 days).
RCT (n=225)
Does early acute decline in eGFR following thiazide administration increase mortality in patients admitted for acute decompensated heart failure?
Early acute declines in kidney function after adding a thiazide to loop diuretics in acute decompensated heart failure are not associated with worse cardiovascular outcomes or mortality.
Effect estimate: HR 0.96 (95% CI 0.47-1.97)
Abstract Background and hypothesis The association between acute declines in estimated glomerular filtration rate (eGFR) among individuals admitted for acute decompensated heart failure (ADHF) and cardiovascular outcomes has been inconsistent. Our objective was to examine whether eGFR decline, and the timing of these declines, are associated with mortality and a composite outcome of mortality or heart failure (HF) hospitalization. Methods We used data from the CLOROTIC Trial, which randomized patients admitted for ADHF to thiazide versus placebo. We examined %eGFR change at 2-days (n = 225) and at 4-days (n = 218) after randomization. Multivariable Cox models were used to evaluate the association between % eGFR change and a primary outcome of mortality and secondary outcome of composite of mortality or HF hospitalization. Results Median %eGFR change was -9.7% (IQR -22.1, 5.4) and -14.4% (-25.1, 7.8) in the thiazide arm at 2-days and 4-days respectively, compared to -0.3% (-7.5, 10.1) and 0% (-10.0, 16.2) in the placebo arm at 2-days and 4-days, respectively. Over a median 3-month follow-up, of those with 2-day eGFR change available, 41 (18%) patients died and 98 (44%) met the composite outcome, and of those with 4-day eGFR change available, 38 (17.4%) died and 95 (43.6%) met the composite outcome. The eGFR decline at 2-days was not associated with risk of mortality (HR = 0.96 95% CI 0.47, 1.97 and HR = 0.89 0.37, 2.10 per 30% eGFR decline in the thiazide and placebo arms, respectively). The eGFR decline at 4-days was not associated with risk of mortality in the thiazide arm (HR = 0.86 0.48, 1.55 per 30% eGFR decline) nor in the placebo (HR = 1.63 0.82, 3.26 per 30% eGFR decline). Associations were similar for the composite outcome. Conclusions Among patients admitted for ADHF and randomized to thiazide vs placebo, early acute declines in eGFR had no association with increased risk of cardiovascular outcomes. Registration Clinicaltrials.gov: NCT01647932; EudraCT Number: 2013–001852-36
McCallum et al. (Sat,) conducted a rct in Acute decompensated heart failure (n=225). Thiazide plus loop diuretics vs. Loop diuretics alone was evaluated on Mortality (HR 0.96, 95% CI 0.47-1.97). Early acute declines in eGFR among ADHF patients treated with thiazide plus loop diuretics were not associated with increased mortality risk (HR 0.96; 95% CI 0.47-1.97 per 30% decline at 2 days).