Heart failure & cardiomyopathies
Hypokalemia During Decongestion With Loop Diuretics and Hydrochlorothiazide, a Post Hoc Analysis of the CLOROTIC Trial
Authors' conclusion
Adding HCTZ to intravenous furosemide increases the risk of hypokalemia a especially when baseline K + is ≤4.3 mmol/L and when patients are not treated with a mineralocorticoid receptor antagonist. In patients treated with furosemide and HCTZ, it is advisable to add potassium supplements or a mineralocorticoid receptor antagonist.
Study context
- Population
- Patients with acute heart failure and volume overload receiving intravenous furosemiderandomized
- Participants
- 230 patients
- Comparison
- Hydrochlorothiazide (HCTZ) or placebo in addition to intravenous furosemide
Methodological detailsrandomized, Monte Carlo simulation
- Randomized
- Monte Carlo simulation
Primary result
As reported in the abstract
Incidence of hypokalemia (K + <3.5 mmol/L) · 48 and 96 hours after randomization, and at discharge
- HCTZ vs placebo: P < 0.001
Further findings
Independent associations with development of hypokalemia (multivariate analysis)
| Comparison | Estimate | P value | |
|---|---|---|---|
| Baseline K + values | OR per 0.1 units 0.82 (95% CI 0.76–0.87) | P < 0.001 | |
| Treatment with HCTZ | OR 4.90 (95% CI 2.50–9.90) | P < 0.001 | |
| Treatment with a mineralocorticoid receptor antagonist at baseline | OR 0.42 (95% CI 0.20–0.84) | P = 0.017 | |
| 0.10.31310Ratio (log scale) |
30- and 90-day mortality and readmissions · 30 and 90 days
- No association between the development of hypokalemia and 30- and 90-day mortality and readmissions
Monte Carlo simulation of hypokalemia risk
- Furosemide alone: higher risk of hypokalemia when baseline K + values are
- ≤3.7 mmol/L
- HCTZ added to furosemide: risk of hypokalemia present with baseline K + values
- ≤4.3 mmol/L
Original publication
Hypokalemia During Decongestion With Loop Diuretics and Hydrochlorothiazide, a Post Hoc Analysis of the CLOROTIC Trial. Circ Heart Fail. Published 1 July 2025. doi:10.
Summarised from the published abstract; every number is checked against it