Efficacy and Safety of Combination Diuretic Therapy in Patients With Acute Decompensated Heart Failure and Volume Overload

Inclusion criteria

• Male or female patients with ages ≥ 18 years old, and less than 65 years old.
• For both elective and emergency hospital admissions, patients with a clinical diagnosis of ADHF must exhibit at least one clinical sign indicative of volume overload. These signs may include edema (score 2 or higher), ascites confirmed through echography, or pleural effusion confirmed by chest X-ray or echography or rales on auscultation, or jugular venous pressure greater than10 mm Hg.

Exclusion criteria

• Patient diagnosed with acute kidney injury upon hospital admission based on the presence of any of the following criteria: an increase in SCr by at least 0.3 mg/dL within 48 hours, an increase in SCr to at least 2 times the baseline value, known or presumed to have occurred within the prior 7 days, and a urine volume less than 0.5 ml/kg/hour for a duration of 6 hours.
• Patients with acute pulmonary edema caused by increased afterload and fluid redistribution to the lungs in the absence or with minimal fluid accumulation.
• Anticipated exposure to nephrotoxic agents (such as contrast dye) during hospitalization.
• Patients who exhibit anuria or are undergoing renal replacement therapy or ultrafiltration.
• Patients with eGFR less than 30 mL/min/1.73m² at the time of screening.
• Expected use of intravenous inotropes, vasopressors, or nitroprusside during the study.
• Prior cardiac transplantation and/or utilization of a ventricular assist device.
• Blood pressure below 90 mmHg or mean arterial pressure below 65 mmHg at the time of recruitment.
• Patients who are pregnant or breastfeeding.
• Administration of acetazolamide or metolazone within the one-month period preceding randomization.
• The usage of any diuretic agent during the treatment phase is not specified in the study protocol, except for mineralocorticoid receptor antagonists.