Secondary analysis
Pre-treatment bicarbonate levels and decongestion by acetazolamide: the ADVOR trial
- Secondary analysis of the ADVOR randomised trial
- double-blind
- placebo-controlled
- subgroup analysis by baseline HCO3
Authors' conclusion
Acetazolamide improves decongestive response over the entire range of HCO3- levels; however, the treatment response is magnified in patients with baseline or loop diuretic-induced elevated HCO3 (marker of proximal nephron NaHCO3 retention) by specifically counteracting this component of diuretic resistance.
Study context
- Population
- Patients with acute HF and volume overload516 with baseline HCO3
- Participants
- 519 patients
- Comparison
- Acetazolamide vs placebo on top of IV loop diuretics, by baseline HCO3
- Primary endpoint
- Complete decongestion
- Follow-up
- After 3 days of treatment (morning of day 4)
Primary result
As reported in the abstract
Complete decongestion, by baseline HCO3
Acetazolamide vs PlaceboOdds ratio (CI)
no elevated HCO3
1.37(0.79–2.37)
elevated HCO3 (≥ 27 mmol/l)
2.39(1.35–4.22)
- Acetazolamide improved decongestive response over the entire range of baseline HCO3- levels
- P = 0.004
Further findings
Increase in HCO3 during treatment · day 3
P < 0.001
Diuretic and natriuretic response, by baseline HCO3
- Higher proportional diuretic and natriuretic response with elevated HCO3
- P for interaction < 0.001
Congestion score on consecutive days, by baseline HCO3
- Greater reduction with elevated HCO3 (treatment × time by HCO3-interaction)
- <0.001
Length of stay, by baseline HCO3
- Greater treatment effect with elevated HCO3
- P for interaction = 0.019
Development of elevated HCO3 in Placebo
- Further worsened decongestive response in the placebo arm
- P for interaction = 0.041
Original publication
Pre-treatment bicarbonate levels and decongestion by acetazolamide: the ADVOR trial. Eur Heart J. Published 4 May 2023. doi:10.1093/eurheartj/ehad236
Summarised from the published abstract; every number is checked against it