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Acute Decompensated Heart FailurePhase 4NCT06414759

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

A Phase 4 study testing Acetazolamide, Metolazone and IV Loop Diuretics in people with Acute Decompensated Heart Failure and Volume Overload, run by Cairo University at 1 site in Egypt.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

This study aims to compare two medications, acetazolamide and metolazone, along with loop diuretics, to see which one works better and is safer for patients with ADHF who have volume overload. By comparing these medications, we hope to learn which one can help these patients the most. Read more about this study

Who is it for?
Ages 18 to 65 years
What is being tested?
Acetazolamide, Metolazone and IV Loop Diuretics
Could I receive a placebo?
No, everyone receives an active treatment
How many people
110 participants
Where
1 siteEgypt
Study dates
1 Jul 2024to 30 Mar 2025
Phase
Phase 4
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 65 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • 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.

Who cannot join

  • 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.
Show all 11Show fewer
  • 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.

Trial locations and contacts

1 site in 1 country.

Mohamed AN Abdelmoaty, B.Sc. Pharmaceutical Sciences contact

+201146631157

mohamed.naguib@miuegypt.edu.eg

Egypt1 site, 1 recruiting
  • National Heart Institute

    Giza, GZ, 3755204

    Mohamed AN Abdelmoaty, B.Sc. Pharmaceutical Sciences, +201146631157, mohamed.naguib@miuegypt.edu.eg

    Bassem Zarif, PhD, Cardiology, +201223950548

    Recruiting

Other trials in Egypt

About this study

This study aims to compare two medications, acetazolamide and metolazone, along with loop diuretics, to see which one works better and is safer for patients with ADHF who have volume overload. By comparing these medications, we hope to learn which one can help these patients the most. This will help doctors choose the best treatment for patients with ADHF and volume overload.

Being tested
Acetazolamide, Metolazone, IV Loop Diuretics
Keywords
ADHF, Acute Decompensated Heart Failure, AHF, Acute Heart Failure, Volume overload, Edema, Loop diuretics, Fusrosemide, Metolazone, Acetazolamide, Carbonic anhydrase inhibitor, Thiazide like diuretics, Thiazide diuretics
Medical subject headings
Edema

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • AcetazolamideDrug

    Also called Carbonic anhydrase inhibitor

    Acetazolamide is a medication that belongs to the class of carbonic anhydrase inhibitors. It acts by reducing the reabsorption of sodium in the proximal tubules of the kidneys. When combined with loop diuretics, acetazolamide has the potential to enhance the effectiveness of diuretic therapy, thus aiding in the process of decongestion.

    It will be given 500mg orally, once daily.

  • MetolazoneDrug

    Also called Thiazide like diuretic

    Metolazone is a medication with properties like thiazide diuretics, prescribed for the management of congestive heart failure and hypertension. Its mechanism of action involves blocking the transport of sodium across the epithelium of renal tubules, predominantly in the distal tubules.

    It will be given 5mg orally, once daily.

  • IV Loop DiureticsDrug

    IV loop diuretic 2 times the outpatient oral (PO) daily dose, and oral loop diuretics will be stopped. In cases where the patient was not previously on oral diuretics, a starting dose of 40 mg of IV furosemide, IV bumetanide 1 mg or a bolus of 20 mg of IV torsemide can be utilized.

Study groups in NCT06414759
Study groupRoleWhat they receive
Group 1ExperimentalFirst group (IV loop Diuretics + oral acetazolamide): patients will receive IV loop diuretic 2 times the outpatient oral (PO) daily dose, and oral loop diuretics will be stopped. In cases where the patient was not previously on oral diuretics, a starting dose of 40 mg of IV furosemide, IV bumetanide 1 mg or a bolus of 20 mg of IV torsemide can be utilized, together with acetazolamide: 500 mg PO once daily.
Receives: Drug: Acetazolamide; Drug: IV Loop Diuretics
Group 2ExperimentalSecond group (IV loop diuretics + oral metolazone): patients will receive IV loop diuretic approximately 2 times the outpatient oral daily dose, and oral loop diuretics will be stopped. In cases where the patient was not previously on oral diuretics, a starting dose of 40 mg of IV furosemide, IV bumetanide 1 mg or a bolus of 20 mg of IV torsemide can be utilized, together with metolazone: 5 mg PO once daily.
Receives: Drug: Metolazone; Drug: IV Loop Diuretics

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Urine Output

    Total Urine output Volume

    Measured: 48 Hours

Secondary outcomes (11)
  1. Diuretic Response

    Urine output/40 mg furosemide equivalent

    Measured: 48 Hours

  2. Body Weight

    Change in Body Weight

    Measured: 48 Hours

  3. Congestion Score

    Change in congestion score (Modified ADVOR Trial Congestion Score)

    Measured: 48 Hours

  4. NT-proBNP/BNP

    Change in NT-Pro BNP/BNP levels

    Measured: On admission and before discharge (After 48 hours)

  5. Bicarbonate Level

    Change in bicarbonate level from baseline [VBG]

    Measured: 48 Hours

  6. Serum Creatinine

    Change in serum creatinine (SCr)

    Measured: 48 Hours

  7. eGFR

    Change in estimated glomerular filtration rate (eGFR) from baseline

    Measured: 48 Hours

  8. Blood Pressure

    Change in systolic blood pressure (SBP) from baseline

    Measured: 48 Hours

  9. Potassium Level

    Change in potassium level from baseline [VBG]

    Measured: 48 Hours

  10. Length of Hospital Stay

    Both general ward and CCU

    Measured: Up to 2 weeks

  11. Mortality or HF Events

    All-cause mortality and heart failure readmission during 3 months of follow-up

    Measured: 3 Months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted16 May 2024
  2. Study start1 Jul 2024
  3. Primary completion30 Dec 2024 (estimated)
  4. Study completion30 Mar 2025 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 4
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
Prospective, randomized, single-blinded, controlled trial
Masking
Single blind
Who is masked
Participant
Enrolment
110 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06414759
Sponsor's protocol ID
CL3575
Other IDs
IHC00077
Status last verified
Jul 2024
First submitted
8 May 2024
Last updated
24 Jul 2024
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No

Publications

  • Arrigo M, Jessup M, Mullens W, Reza N, Shah AM, Sliwa K, Mebazaa A. Acute heart failure. Nat Rev Dis Primers. 2020 Mar 5;6(1):16. doi: 10.1038/s41572-020-0151-7.

    PubMed 32139695
  • Njoroge JN, Teerlink JR. Pathophysiology and Therapeutic Approaches to Acute Decompensated Heart Failure. Circ Res. 2021 May 14;128(10):1468-1486. doi: 10.1161/CIRCRESAHA.121.318186. Epub 2021 May 13.

    PubMed 33983837
  • Hsiao R, Greenberg B. Contemporary Treatment of Acute Heart Failure. Prog Cardiovasc Dis. 2016 Jan-Feb;58(4):367-78. doi: 10.1016/j.pcad.2015.12.005. Epub 2016 Jan 5.

    PubMed 26764279
  • Kurmani S, Squire I. Acute Heart Failure: Definition, Classification and Epidemiology. Curr Heart Fail Rep. 2017 Oct;14(5):385-392. doi: 10.1007/s11897-017-0351-y.

    PubMed 28785969
  • Rubio-Gracia J, Demissei BG, Ter Maaten JM, Cleland JG, O'Connor CM, Metra M, Ponikowski P, Teerlink JR, Cotter G, Davison BA, Givertz MM, Bloomfield DM, Dittrich H, Damman K, Perez-Calvo JI, Voors AA. Prevalence, predictors and clinical outcome of residual congestion in acute decompensated heart failure. Int J Cardiol. 2018 May 1;258:185-191. doi: 10.1016/j.ijcard.2018.01.067.

    PubMed 29544928
  • Mentz RJ, Kjeldsen K, Rossi GP, Voors AA, Cleland JG, Anker SD, Gheorghiade M, Fiuzat M, Rossignol P, Zannad F, Pitt B, O'Connor C, Felker GM. Decongestion in acute heart failure. Eur J Heart Fail. 2014 May;16(5):471-82. doi: 10.1002/ejhf.74. Epub 2014 Mar 5.

    PubMed 24599738
  • Felker GM, Lee KL, Bull DA, Redfield MM, Stevenson LW, Goldsmith SR, LeWinter MM, Deswal A, Rouleau JL, Ofili EO, Anstrom KJ, Hernandez AF, McNulty SE, Velazquez EJ, Kfoury AG, Chen HH, Givertz MM, Semigran MJ, Bart BA, Mascette AM, Braunwald E, O'Connor CM; NHLBI Heart Failure Clinical Research Network. Diuretic strategies in patients with acute decompensated heart failure. N Engl J Med. 2011 Mar 3;364(9):797-805. doi: 10.1056/NEJMoa1005419.

    PubMed 21366472
  • Hoorn EJ, Ellison DH. Diuretic Resistance. Am J Kidney Dis. 2017 Jan;69(1):136-142. doi: 10.1053/j.ajkd.2016.08.027. Epub 2016 Nov 1.

    PubMed 27814935
  • Suri SS, Pamboukian SV. Optimal diuretic strategies in heart failure. Ann Transl Med. 2021 Mar;9(6):517. doi: 10.21037/atm-20-4600.

    PubMed 33850914
  • McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Bohm M, Burri H, Butler J, Celutkiene J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Kathrine Skibelund A; ESC Scientific Document Group. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021 Sep 21;42(36):3599-3726. doi: 10.1093/eurheartj/ehab368. No abstract available.

    PubMed 34447992
  • Sica DA. Metolazone and its role in edema management. Congest Heart Fail. 2003 Mar-Apr;9(2):100-5. doi: 10.1111/j.1527-5299.2003.01907.x.

    PubMed 12671341
  • Cox ZL, Hung R, Lenihan DJ, Testani JM. Diuretic Strategies for Loop Diuretic Resistance in Acute Heart Failure: The 3T Trial. JACC Heart Fail. 2020 Mar;8(3):157-168. doi: 10.1016/j.jchf.2019.09.012. Epub 2019 Dec 11.

    PubMed 31838029
  • Verbrugge FH, Dupont M, Bertrand PB, Nijst P, Penders J, Dens J, Verhaert D, Vandervoort P, Tang WH, Mullens W. Determinants and impact of the natriuretic response to diuretic therapy in heart failure with reduced ejection fraction and volume overload. Acta Cardiol. 2015 Jun;70(3):265-73. doi: 10.1080/ac.70.3.3080630.

    PubMed 26226699
  • Verbrugge FH, Martens P, Ameloot K, Haemels V, Penders J, Dupont M, Tang WHW, Droogne W, Mullens W. Acetazolamide to increase natriuresis in congestive heart failure at high risk for diuretic resistance. Eur J Heart Fail. 2019 Nov;21(11):1415-1422. doi: 10.1002/ejhf.1478. Epub 2019 May 9.

    PubMed 31074184
  • Mullens W, Dauw J, Martens P, Verbrugge FH, Nijst P, Meekers E, Tartaglia K, Chenot F, Moubayed S, Dierckx R, Blouard P, Troisfontaines P, Derthoo D, Smolders W, Bruckers L, Droogne W, Ter Maaten JM, Damman K, Lassus J, Mebazaa A, Filippatos G, Ruschitzka F, Dupont M; ADVOR Study Group. Acetazolamide in Acute Decompensated Heart Failure with Volume Overload. N Engl J Med. 2022 Sep 29;387(13):1185-1195. doi: 10.1056/NEJMoa2203094. Epub 2022 Aug 27.

    PubMed 36027559

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing Acetazolamide, Metolazone and IV Loop Diuretics in people with Acute Decompensated Heart Failure and Volume Overload, run by Cairo University at 1 site in Egypt.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 2 inclusion and 11 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: status not confirmed, as of the sponsor's last update on 24 Jul 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Egypt. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

Contact Mohamed AN Abdelmoaty, B.Sc. Pharmaceutical Sciences (+201146631157, mohamed.naguib@miuegypt.edu.eg), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Urine Output (time frame: 48 Hours). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT06414759, which also lists 22 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 24 Jul 2024.

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