Acute declines in kidney function with thiazide plus loop diuretics versus loop diuretics alone in acute decompensated heart failure.
Wendy McCallum, Hocine Tighiouart, Marcelle Tuttle et al.
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In 30 seconds
This analysis of the randomized CLOROTIC trial examined whether early eGFR changes were associated with outcomes in patients admitted with acute decompensated heart failure and randomized to thiazide or placebo alongside loop diuretics. eGFR change was assessed at 2 and 4 days, with outcomes evaluated over a median 3-month follow-up. Declines were greater with thiazide, but were not associated with increased mortality or the composite of mortality or heart-failure hospitalization. For example, per 30% eGFR decline at 2 days, mortality HRs were 0.96 (95% CI 0.47, 1.97) with thiazide and 0.89 (0.37, 2.10) with placebo.
Key findings
- Median eGFR change at 2 days was -9.7% (IQR -22.1, 5.4) with thiazide and -0.3% (IQR -7.5, 10.1) with placebo.
- At 4 days, median eGFR change was -14.4% (IQR -25.1, 7.8) with thiazide and 0% (IQR -10.0, 16.2) with placebo.
- Neither 2-day nor 4-day eGFR decline was associated with increased mortality; associations were similar for mortality or heart-failure hospitalization.
Why it matters
Kidney-function changes during treatment for acute decompensated heart failure can raise concern about subsequent cardiovascular risk. In this trial population, early eGFR declines were not associated with worse mortality or the composite outcome, including when declines occurred in the thiazide arm. This helps contextualize early laboratory changes, while the findings do not establish that such declines are harmless in other populations or settings.
What to keep in mind
The analysis included patients with eGFR measurements available at 2 or 4 days, and follow-up was a median of 3 months; the findings may not apply beyond this trial population or period.