Heart failure & cardiomyopathiesSecondary analysis
Sodium and Potassium Changes During Decongestion with Acetazolamide – A Pre-Specified Analysis from the ADVOR Trial
- Secondary analysis of the ADVOR randomised trial
- pre-specified sub-analysis
Authors' conclusion
Acetazolamide on top of standardized loop diuretic therapy does not lead to clinically important hypokalaemia or hyponatraemia and improves decongestion over the entire range of baseline serum potassium and sodium levels.
Study context
- Population
- Patients with acute HF and volume overload
- Participants
- 519 patients
- Comparison
- IV acetazolamide vs placebo on top of standardized IV loop diuretics
- Primary endpoint
- Changes in serum sodium and potassium levels and modification of acetazolamide's treatment effect by baseline values
Primary result
As reported in the abstract
Hyponatraemia · After 3 days of treatment
P = 0.255
- Slight decrease in mean potassium with acetazolamide, non-significant over time
- P = 0.053
- No significant impact on hypokalaemia incidence
- P = 0.061
Further findings
| Outcome | Acetazolamide | Placebo |
|---|---|---|
| Baseline potassium and sodium at randomization | ||
| Potassium | 4.2 ± 0.6 | 4.2 ± 0.6 |
| Sodium | 139 ± 4 | 140 ± 4 |
- Baseline potassium and sodium at randomization — Hypokalaemia (<3.5 mmol/L) on admission
- 44 (9%)
- Baseline potassium and sodium at randomization — Hyponatraemia (≤135 mmol/L) on admission
- 82 (16%)
Safety
| Outcome | P value |
|---|---|
| Severe hypokalaemia (<3.0 mmol/L) · similarly distributed between arms | P = 0.676 |
- Severe hypokalaemia (<3.0 mmol/L) — Severe hypokalaemia, all patients
- 7 (1%)
Original publication
Sodium and Potassium Changes During Decongestion with Acetazolamide – A Pre-Specified Analysis from the ADVOR Trial. Eur J Heart Fail. Published 10 May 2023. doi:10.1002/ejhf.2863
Summarised from the published abstract; every number is checked against it