Comparison of Oral Metolazone versus Oral Chlorothiazide in Patients with Acute Decompensated Heart Failure with Loop Diuretic Resistance Open Access
Wang, Xiao (Spring 2020)
Backgrounds: Adult patients admitted with acute decompensated heart failure (ADHF) between July 1st, 2016 to July 31st, 2018 with loop diuretic resistance, defined as administration of intravenous (IV) furosemide during hospitalization and at least one dose of oral chlorothiazide (22 patients) or oral metolazone (53 patients) to augment diuresis to compare the efficacy and safety between oral chlorothiazide and metolazone in ADHF patients with loop diuretic resistance.
Methods: We conducted a retrospective, single-center, cohort study between and the two cohorts and used appropriate tests and regression models to see the differences. The primary end point was the change in 24-hour UOP (urine output) from loop diuretic only administration to combination diuretic administration with a thiazide-type diuretic. Secondary end points included change in patients’ body weight, in serum creatinine, serum electrolytes, length of stay (LOS), need for intensive care unit (ICU) transfer, and 30-day readmission after the thiazide-type diuretic and the baseline characteristics for each group.
Results: 24-hour UOP after loop diuretic only administration was similar between the patients who received oral chlorothiazide and those who received metolazone (2135.2 ± 1161.0 vs. 1855.6 ± 1231.0, p=0.366) and the addition of a thiazide-type diuretic similarly increased 24-hour UOP for both (2950.7 ± 1345.6 vs. 3151.1 ± 1349.2, p = 0.559). The change in UOP output was similar (815.5 mL ± 1505.8 vs. 1295 mL ± 1857.9, p = 0.290) and reaffirmed by GLM analysis (p = 0.149). No significant differences in change in LOS (8.3 days ± 5.7 vs. 10.4 days ± 8.8, p = 0.304, GLM p-value =0.528), and ICU transfer rates (22.72% vs. 20.75%, p = 0.849, LRM p-value = 0.886). A significant weight change between after the two thiazide-type diuretic and the baseline weight (-0.5 kg ± 1.7 vs. -2.1 kg ± 2.6, p = 0.016, GLM p-value = 0.02) and 30-day readmission rates between the two cohorts (20.8% vs. 45.5%, p = 0.030, LRM p-value = 0.085). We also found a similar change in serum creatinine concentration (0.04 mg/dL ± 0.263 in the chlorothiazide group vs. 0.13 mg/dL ± 0.304 in the metolazone group, p=0.297, GLM p-value = 0.961), serum sodium (-0.10 mg/dL ± 2.142 vs. -0.90 mg/dL ± 3.054, p = 0.274, GLM p-value = 0.391), serum potassium (-0.39 mg/dL ± 1.011 vs. -0.14 mg/dL ± 0.509, p = 0.168, GLM p-value = 0.143), or serum magnesium (0.08 mg/dL ± 0.196 vs. 0.03 mg/dL ± 0.234, p = 0.489, GLM p-value = 0.761).
Conclusions: In patients with ADHF and loop diuretic resistance, the addition of oral chlorothiazide or metolazone resulted in similar 24-hour urine output without change in renal function or serum electrolytes. These findings suggest similar efficacy and safety between oral chlorothiazide and metolazone in this patient population. However, additional studies with a larger sample size are recommended to assess non-inferiority.
Table of Contents
2. Methods 3
2.1 Study design and Data collection. 3
2.2 Statistical Analysis 4
3. Results 5
3.1 baseline characteristics 5
3.2 Efficacy Outcomes 6
3.2.1 primary outcomes 6
3.2.2 Secondary outcomes 7
3.3 Safety outcomes 7
3.3.1 Third outcomes 7
4. Discussions 11
5. Conclusions 12
About this Master's Thesis
|Committee Chair / Thesis Advisor|
|Comparison of Oral Metolazone versus Oral Chlorothiazide in Patients with Acute Decompensated Heart Failure with Loop Diuretic Resistance ()||2020-04-22 18:49:19 -0400||