Hypokalemia During Decongestion With Loop Diuretics and Hydrochlorothiazide, a Post Hoc Analysis of the CLOROTIC Trial.

IF 8.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Circulation: Heart Failure Pub Date : 2025-09-01 Epub Date: 2025-07-01 DOI:10.1161/CIRCHEARTFAILURE.125.012914

Alicia Conde-Martel, Marta Hernández-Meneses, José Luís Morales-Rull, Jesús Casado, Margarita Carrera-Izquierdo, Marta León, Marta Sánchez-Marteles, Melitón Francisco Dávila-Ramos, Carolina Hernández-Carballo, Pau Llácer, Mari Carmen Moreno-García, Prado Salamanca-Bautista, Francesc Formiga, Luís Manzano, Joan Carles Trullàs

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引用次数: 0

Abstract

Background: In patients with acute heart failure, the addition of hydrochlorothiazide (HCTZ) to furosemide increased the diuretic response in the CLOROTIC trial (Combining Loop with Thiazide Diuretics for Decompensated Heart Failure). The aim of this subanalysis was to evaluate the incidence and risk factors for hypokalemia, and its impact on mortality and readmissions.

Methods: This is a post hoc analysis of the CLOROTIC trial that randomized 230 patients with acute heart failure and volume overload to receive HCTZ or placebo in addition to intravenous furosemide. The incidence and risk factors for the development of hypokalemia (K⁺ <3.5 mmol/L) and its association with 30- and 90-day mortality and readmissions were analyzed. The Monte Carlo simulation method was applied to predict the development of hypokalemia.

Results: The incidence of hypokalemia was significantly higher in the HCTZ group (compared with the placebo group) at 48 and 96 hours after randomization, and at discharge (P<0.001). In a multivariate analysis, the following variables were independently associated with the development of hypokalemia: baseline K⁺ values (OR per 0.1 units, 0.82 [95% CI, 0.76-0.87]; P<0.001), treatment with HCTZ (OR, 4.90 [95% CI, 2.50-9.90]; P<0.001), and treatment with a mineralocorticoid receptor antagonist at baseline (OR, 0.42 [95% CI, 0.20-0.84]; P=0.017). There was no association between the development of hypokalemia and 30- and 90-day mortality and readmissions. The Monte Carlo simulation method predicted in patients treated with furosemide alone a higher risk of hypokalemia when baseline K⁺ values are ≤3.7 mmol/L. When HCTZ is added to furosemide, the risk of hypokalemia is present with higher baseline K⁺ values (≤4.3 mmol/L).

Conclusions: Adding HCTZ to intravenous furosemide increases the risk of hypokalemia a especially when baseline K⁺ is ≤4.3 mmol/L and when patients are not treated with a mineralocorticoid receptor antagonist. In patients treated with furosemide and HCTZ, it is advisable to add potassium supplements or a mineralocorticoid receptor antagonist.

Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01647932.

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循环利尿剂和氢氯噻嗪去充血期间的低钾血症，CLOROTIC试验的事后分析。

背景：在急性心力衰竭患者中，在速尿中加入氢氯噻嗪（HCTZ）增加了CLOROTIC试验（联合环与噻嗪类利尿剂治疗失代偿性心力衰竭）的利尿反应。本亚组分析的目的是评估低钾血症的发生率和危险因素，及其对死亡率和再入院率的影响。方法：这是对cloortic试验的事后分析，该试验随机分配230例急性心力衰竭和容量超载患者，在静脉注射速尿的同时接受HCTZ或安慰剂。结果：在随机分组后48和96小时，以及在出院时，HCTZ组（与安慰剂组相比）的低钾血症发生率显著更高(P+值(OR / 0.1单位，0.82 [95% CI, 0.76-0.87]；购买力平价= 0.017)。低钾血症的发生与30天和90天死亡率和再入院之间没有关联。蒙特卡罗模拟方法预测，当基线K+值≤3.7 mmol/L时，单独使用呋塞米治疗的患者发生低钾血症的风险较高。当将HCTZ添加到速尿中时，低钾血症的风险存在，基线K+值较高（≤4.3 mmol/L）。结论：在静脉速尿中加入HCTZ会增加低钾血症的风险，特别是当基线K+≤4.3 mmol/L和患者未接受矿皮质激素受体拮抗剂治疗时。在接受呋塞米和HCTZ治疗的患者中，建议添加钾补充剂和矿皮质激素受体拮抗剂。注册：网址：https://www.clinicaltrials.gov；唯一标识符：NCT01647932。

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来源期刊

Circulation: Heart Failure 医学-心血管系统

CiteScore

12.90

自引率

3.10%

发文量

271

审稿时长

6-12 weeks

期刊介绍： Circulation: Heart Failure focuses on content related to heart failure, mechanical circulatory support, and heart transplant science and medicine. It considers studies conducted in humans or analyses of human data, as well as preclinical studies with direct clinical correlation or relevance. While primarily a clinical journal, it may publish novel basic and preclinical studies that significantly advance the field of heart failure.