EFFECTS OF THE ASSOCIATION BETWEEN LOOP DIURETICS AND HYDROCHLOROTHIAZIDE IN PATIENTS WITH ACUTELY DECOMPENSATED HEART FAILURE AND ACUTE KIDNEY INJURY: A RANDOMIZED CONTROLLED CLINICAL TRIAL

• Grant number: 25/01832-7
• Support Opportunities: Scholarships in Brazil - Scientific Initiation
• Start date: April 01, 2025
• End date: March 31, 2026
• Field of knowledge: Health Sciences - Medicine - Medical Clinics
• Principal Investigator: Caroline Ferreira da Silva Mazeto Pupo da Silveira
• Grantee: Beatriz Koti Lazzari
• Host Institution: Faculdade de Medicina (FMB). Universidade Estadual Paulista (UNESP). Campus de Botucatu. Botucatu , SP, Brazil

Abstract

Introduction: Acutely decompensated heart failure (ADHF) is a systemic pathology that presents as a recurrent complication acute kidney injury (AKI), with the use of loop diuretics being frequent in the treatment of ADHF. The chronic use of these medications, however, and the consequent resistance developed to them are configured as a challenge, so the addition of a thiazide diuretic is a strategy that aims to increase the efficiency of the treatment, although the evaluation of this combination in ADHF and AKI is still limited. Objective: To evaluate The effect of adding hydrochlorothiazide to intravenous loop diuretic therapy in ADHF pacientes with signs of volume overload and AKI. Method: The study will be a clinical trial, controller, randomized, non-blind, and single-center study. Included patients must present ADHF, AKI KDIGO 1 or 2 and clinical signs of volume overload. As non-inclusion criteria, there are the use of vasoactive drugs, chronic kidney disease stage 5 or AKI KDIGO 3 on admission, systolic blood pressure below 90 mmHg, presence of hemodynamically significant arrhythmias, hypokalemia or hyponatremia on admission with values equal to or less than 2,5 or 125 mmol/L, respectively, inability to comply with study planning or refusal to participate. Patients will be randomized into two groups to recive one of the following interventions: bolus intravenous loop diuretics and bolus intravenous loop diuretics together with hydrochlorothiazide. As primary outcomes there are clinical improvement in signs of congestion, changes in body weight and changes in patient-reported dyspnea at 72 hours after randomization. Secondary outcomes include lenght of hospital stay, rehospitalization for heart failure, assessment of AKI progression to KDIGO 3 and mortality during 3 months of follow-up.