Revisión sistemática
Published on 30 de julio de 2026 | http://doi.org/10.5867/medwave.2026.06.3217
Effectiveness and safety of acetazolamide plus loop diuretics in acute congestive heart failure: A living systematic review - Version 2026 1.0
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Baseline characteristics of included studies.
| Number of patients | 519 (256 acetazolamide, 259 control) | 34 (18 acetazolamide, 16 control) | 20 (10 acetazolamide, 10 control) | 61 (31 acetazolamide, 30 control) |
| Study and follow-up duration | 3 days (primary outcome); 3-month follow-up | 3 days; 34-month follow-up | 4 days (acetazolamide on days 2–3) | 3 days from start until discharge |
| Baseline characteristics of the population | Mean age 78.2 years, 37,4% female, median NT-proBNP 6173 pg/mL,median GFR 39 ml/min/1,73m2 | Mean age 80 years, 35% female, median NT-proBNP 7849 ng/L, median GFR 31 ml/min/1,73m2 | Mean age 72 years, 15% female, median NT-proBNP 8064 pg/mL, median GFR not reported | Mean age 68 years, 29% female, median NT-proBNP 7045 pg/mL, median GFR 58 ml/min/1,73m2 |
| Intervention | IV acetazolamide 500 mg/day + standardized IV furosemide (double home dose) | Acetazolamide (250–500 mg daily) combined with low-dose loop diuretics (bumetanide 1 to 2 mg twice daily) | Oral acetazolamide adjusted by weight (250–500 mg) on days 2 to 3 | Oral acetazolamide 250 mg/day up to day 3 + standard IV furosemide |
| Comparison | Placebo + standardized IV furosemide | High-dose loop diuretics (twice the oral maintenance dose) | No additional treatment | Standard IV furosemide |
| Primary outcome | Successful decongestion at 3 days (no residual edema, ascites, pleural effusion; no therapy escalation) | Total natriuresis (mmol) at 24h | Daily diuresis and fluid balance, differences across days 1 to 4 | Cumulative diuresis, fluid balance, natriuresis, chloride recovery |
| Funding for study | None | Funded by the Research Foundation – Flanders PhD fellowships and the Limburg Clinical Research Program, supported by LSM, Hasselt University, Ziekenhuis Oost-Limburg, and Jessa Hospital | Centre of Postgraduate Medical Education Grant. The study drug was provided free of charge by the Polish manufacturer | Subsidy no. Sub.e190.19.052 |
GFR: glomerular filtration rate, NT-proBNP: N-terminal pro–B-type natriuretic peptide.
Souce: Prepared by the authors of this study.