Efficacy of Combining Acetazolamide with Loop Diuretics Versus Using Double Dose Loop Diuretics for Decongestion in Patients with Chronic Kidney Disease: A Randomized Controlled Trial

Background The combination of acetazolamide and loop diuretics in hospitalized heart failure patients has demonstrated positive results in improving diuresis and decongestion. However, the effectiveness of this combination in chronic kidney disease (CKD) patients with volume overload remains to be determined. Methods CKD patients with fluid overload, confirmed by bioimpedance spectroscopy, were randomized to receive either oral acetazolamide 250 mg/day plus furosemide or a doubled dose of furosemide. Volume status, changes in body fluid compartments (assessed by body composition monitoring), and urinary sodium were evaluated at baseline and 2 weeks. The primary outcomes were the proportion of patients with a bodyweight reduction of more than 2 kg or 5% and the mean change in body weight at 2 weeks. Results Fifty-two CKD patients with an estimated glomerular filtration rate of 38 mL/min/1.73 m² were included. Body weight reduction of more than 2 kg at week 2 occurred in 40.7% of the combination group compared to 12% of the doubled-dose group (risk ratio [RR] 3.39, 95% confidence interval [CI] 1.06–10.7). Body weight reduction of more than 5% at week 2 occurred in 25.9% of the combination group compared to 0% of the doubled-dose group (RR 2.25, 95% CI 1.62–3.12). The mean difference in body weight reduction between the combination and doubled-dose groups was − 1.37 kg (95% CI -2.50 to -0.24). No serious adverse events were reported in either group. Conclusion Adding acetazolamide to loop diuretics improves volume overload in CKD patients without significant or serious side effects.