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Abstract: FR-PO296

Acetazolamide Therapy in Patients with Heart Failure: A Meta-Analysis

Session Information

Category: Fluid and Electrolytes

  • 902 Fluid and Electrolytes: Clinical

Authors

  • Wongboonsin, Janewit, Univeristy of Minnesota, Minneapolis, Minnesota, United States
  • Thongprayoon, Charat, Bassett Medical Center, Cooperstown, New York, United States
  • Cheungpasitporn, Wisit, University of Mississippi, Jackson, Mississippi, United States
Background

Fluid overload and central sleep apnea are highly prevalent in patients with heart failure (HF). Acetazolamide, although used as one of the first diuretics for heart failure, has not been readily added on as a therapy for diuretic resistance. In addition, its use in sleep apnea disorder has shown promising results, at least in the setting of high altitude conditions. We performed this meta-analysis to assess effects of acetazolamide therapy on 1) fluid and/or electrolytes, and 2)apnea indexes in heart failure patients.

Methods

A literature search was conducted using MEDLINE, EMBASE and Cochrane Database from inception through June 2017 to identify studies evaluating the use of acetazolamide in HF patients. Study results were pooled and analyzed using a random effects model. The protocol for this meta-analysis is registered with PROSPERO (International Prospective Register of Systematic Reviews; no. CRD42017065401).

Results

9 studies (3 randomized controlled trials and 6 cohort studies) with a total of 229 HF patients were enrolled. After acetazolamide treatment, there were significant decreases in pH (mean difference [MD] of -0.04 [95% CI, -0.06 to -0.02]), pCO2 (MD of -2.06 mmHg [95% CI, -3.60 to -0.53 mmHg]) and serum bicarbonate levels (MD of -6.42 mmol/L [95% CI, -10.05 to -2.79 mmol/L]). Compared with placebo, acetazolamide significantly increased natriuresis (standardized mean difference [SMD] of 0.67 [95% CI, 0.08 to 1.27]), and decreased the apnea-hypopnea index (AHI) (SMD of -1.06, [95% CI, -1.75 to -0.36]) and central apnea index (CAI) (SMD of -1.10, [95% CI, -1.80 to -0.40]), respectively. We found no publication bias as assessed by the funnel plots and Egger’s regression asymmetry test with p= 0.20, 0.75 and 0.59 for analysis of the changes of pH, pCO2, and serum bicarbonate levels with the use of acetazolamide in HF patients, respectively.

Conclusion

Our study demonstrates significant reduction in pH, increase in natriuresis, and improvements in apnea indexesamong HF patients with acetazolamide.