Effectiveness and safety of combining thiazides with loop diuretics vs. loop diuretics monotherapy in patients with acute decompensated heart failure: A retrospective cohort study.

AIMS: This study investigated factors associated with and outcomes of combined loop diuretics with hydrochlorothiazide (HCTZ) for acute decompensated heart failure (ADHF).

METHODS

In this retrospective study, adults hospitalized for ADHF and who received intravenous loop diuretics between January 2016 and March 2023 were enrolled. Patients were categorized into two groups based on HCTZ use. Factors associated with combination therapy and clinical outcomes were examined. Effectiveness outcomes included weight change and percentage weight change, while safety outcomes focused on acute kidney injury (AKI) and worsening renal function at discharge.

RESULTS

Among 3493 enrolled patients, 329 received combination therapy. Factors associated with combination therapy included use of thiazide diuretics pre-admission (adjusted odds ratio [aOR]: 1.81; 95% confidence interval [CI]: 1.25-2.62), pre-admission dose of oral loop diuretics (aOR: 1.28 per defined daily dose; 95% CI: 1.05-1.56), lower estimated glomerular filtration rate (aOR: 0.98 per unit; 95% CI: 0.98-0.99), higher N-terminal pro-B-type natriuretic peptide levels (aOR: 1.02 per 1000 unit; 95% CI: 1.01-1.02), and lower serum albumin (aOR: 0.53 per unit; 95% CI: 0.41-0.68). Compared to loop diuretics monotherapy, weight reduction was greater in combination therapy (adjusted difference -1.2 kg; 95% CI: -1.5 to -0.9) and percentage of weight loss (adjusted difference -1.8%; 95% CI: -2.3 to -1.3), but higher risk of AKI (aOR: 2.7; 95% CI: 2.1-3.5) and worsening renal function at discharge (aOR: 2.4; 95% CI: 1.9-3.1).

CONCLUSIONS

Combination therapy enhanced weight reduction in ADHF; however, it might increase the risk of renal dysfunction.