Efficacy of the Combination of Acetazolamide with Loop Diuretics vs. Double-Dose Loop Diuretics for Decongestion in CKD Patients: A Randomized Controlled Trial

Background: The combination of acetazolamide and loop diuretics in the setting of hospitalized heart failure has shown promising results in improving diuresis and decongestion. However, the effectiveness of this combination in chronic kidney disease (CKD) with volume overload has yet to be determined. Methods: CKD patients with fluid overload, confirmed by bioimpedance spectroscopy, were allocated to receive oral acetazolamide 250 mg/day plus furosemide or a doubled dose of furosemide. Volume status, changes of body fluid compartment from body composition monitoring, and urinary sodium were evaluated at baseline, 2, and 4 weeks. The main outcome was the proportion of body weight reduction (> 2 kg and 5%) and mean change of body weight at 2 weeks. Results: Fifty-two CKD patients with an estimated glomerular filtration rate of 38 mL/min/1.73 m2 were included. Body weight reduction > 2 kg at week 2 (40.7% vs. 12%, risk ratio (RR) 3.39, 95% CI 1.06-10.7) and body weight reduction > 5% at week 2 (25.9% vs 0% RR 2.25, 95%CI 1.62-3.12) significantly occurred in the combination group compared to the doubled-dose group. Additionally, mean difference of body weight reduction between combination group and doubled dose group was -1.37 kg, 95%CI -2.498, -0.242). The combination group showed lower rates of alkalosis and hypokalemia at 4 weeks. No serious adverse events were found in either group. Conclusion: Adding acetazolamide to loop diuretics ameliorates volume overload in CKD patients without significant or serious side effects. Funding: Government Support – Non-U.S.Primary outcome Body weight reduction at week 2