Heart failure & cardiomyopathiesSecondary analysis
Kidney function and acid–base status as gatekeepers of natriuretic and diuretic responsiveness in chronic heart failure (HF): insights from the DEA-HF clinical trial
- prespecified post-hoc analysis of DEA-HF, a randomized, crossover trial
Authors' conclusion
In ambulatory patients with congestion-refractory HF and eGFR > 30 mL/min/1.73m2, natriuretic and diuretic responses are augmented across all regimens, with metolazone providing additional improvement in natriuresis. When eGFR ≤ 30 mL/min/1.73m2, neither metolazone nor acetazolamide provides additional benefit. High serum bicarbonate predicts better natriuretic and diuretic response, as well as additional benefit from metolazone treatment. High-dose diuretics had comparable safety profiles across the eGFR spectrum.
Study context
- Population
- Congestion-refractory chronic HF patients
- Participants
- 42 patients
- Comparison
- Effect modification by eGFR (≤30 vs. > 30 mL/min/1.73m2) and by serum bicarbonate (≤vs.> median-29.6 mmol/L) on three diuretic regimens
- Primary endpoint
- 6h-Natriuresis
- Follow-up
- 6h
Primary result
As reported in the abstract
- No regimen differences at eGFR ≤ 30
- eGFR > 30 vs eGFR ≤30: 4735 mg vs. 3211 mg mg; P = 0.0004
- metolazone + furosemide vs acetazolamide + furosemide: 5525 mg vs. 4379 mg mg; P = 0.04
- metolazone + furosemide vs furosemide monotherapy: 5525 mg vs. 4303 mg mg; P = 0.014
- higher serum bicarbonate vs lower serum bicarbonate: 4858 mg vs. 3576 mg mg; P = 0.0008
Further findings
| Outcome | Estimate | P value |
|---|---|---|
| 6h-diuresis — eGFR > 30 vs eGFR ≤30 · higher with higher eGFR | 1.93L vs. 1.49L L | P = 0.0078 |
| 6h-diuresis — higher serum bicarbonate vs lower serum bicarbonate · higher with higher bicarbonate | 1.99 vs. 1.56L L | P = 0.0014 |
Clinical decongestion measures · 7 ± 3 days
- There was no difference in clinical decongestion measures
Original publication
Kidney function and acid–base status as gatekeepers of natriuretic and diuretic responsiveness in chronic HF: insights from the DEA-HF clinical trial. Eur Heart J Cardiovasc Pharmacother. Published 18 May 2026. doi:10.1093/ehjcvp/pvag019
Summarised from the published abstract; every number is checked against it