Natriuresis With Acetazolamide or SGLT2 Inhibitors Added to Intravenous Loop Diuretics in Decompensated Heart Failure (GLIDE-DHF)
Natriuresis in Decompensated Heart Failure Patients Treated With Intravenous Loop Diuretics Alone or in Combination With an SGLT2 Inhibitor or Acetazolamide: a Single-Center, Prospective, Open-Label, Non-Randomized, Controlled Interventional Study (GLiflozin or AcetazolamIDE on Top of Loop Diuretics in Decompensated Heart Failure)
The GLIDE-DHF study compares the natriuretic effect of adding acetazolamide or a sodium-glucose co-transporter 2 inhibitor (SGLT2i) to intravenous loop diuretics, versus intravenous loop diuretics alone, in patients admitted to the emergency department with acute decompensated heart failure. Natriuresis is assessed by spot urinary sodium concentration measured 6 hours after the first study treatment. The study also evaluates changes in urinary and serum electrolytes, kidney function, blood pressure, clinical congestion and safety during the first 3 days of treatment.
Panoramica dello studio
Stato
Stato
Condizioni
Condizioni
Intervento / Trattamento
Intervento / Trattamento
Tipo di studio
Tipo di studio
Iscrizione (Effettivo)
Iscrizione
Fase
Fase
- Fase 4
Contatti e Sedi
Luoghi di studio
-
-
Porto District
-
Porto, Porto District, Portogallo, 4200-319
- Unidade Local de Saúde São João
-
-
Criteri di partecipazione
Criteri di ammissibilità
Criteri di ammissibilità
Età idonea allo studio
Accetta volontari sani
Sessi ammissibili allo studio
Descrizione
Inclusion Criteria:
- Age ≥18 years
- Admission to the emergency department with a primary diagnosis of decompensated heart failure
- Inclusion within the first 24 hours after emergency department admission
- In patients who received intravenous loop diuretics before inclusion, baseline urine sample collected at least 6 hours after the last loop diuretic dose
- Written informed consent
Exclusion Criteria:
- Hemodynamic instability (systolic blood pressure <90 mmHg and/or serum lactate >2 mmol/L)
- Decompensated heart failure in the setting of an acute coronary syndrome
- Chronic maintenance therapy with an SGLT2 inhibitor or acetazolamide before the current episode
- Baseline estimated glomerular filtration rate (outside the acute episode) <20 mL/min/1.73 m²
- Renal replacement therapy
- Metabolic or respiratory acidosis (arterial pH <7.35)
- Sodium bicarbonate administration before inclusion
Piano di studio
Come è strutturato lo studio?
Dettagli di progettazione
- Scopo principale: Trattamento
- Assegnazione: Non randomizzato
- Modello interventistico: Assegnazione sequenziale
- Mascheramento: Nessuno (etichetta aperta)
Numero di armi
Armi e interventi
Gruppo di partecipanti / ArmGruppo di partecipanti / Arm |
Intervento / TrattamentoIntervento / Trattamento |
|---|---|
|
Comparatore attivo: Loop diuretic alone (LD)
Intravenous furosemide. Initial dose: twice the oral outpatient dose (maximum 160 mg IV), or 40 mg IV in patients not on chronic loop diuretics. Subsequent dose adjustments at the attending physician's discretion. |
Intravenous furosemide; initial dose twice the oral outpatient dose (max 160 mg) or 40 mg if loop diuretic-naïve; subsequent adjustments per attending physician. |
|
Sperimentale: Loop diuretic + SGLT2 inhibitor (LD+SGLT2i)
Intravenous furosemide (as in the LD arm) plus oral dapagliflozin 10 mg or empagliflozin 10 mg once daily, started on day 1. SGLT2i may be continued after day 3. |
Intravenous furosemide; initial dose twice the oral outpatient dose (max 160 mg) or 40 mg if loop diuretic-naïve; subsequent adjustments per attending physician. Oral dapagliflozin 10 mg once daily. Oral empagliflozin 10 mg once daily. |
|
Sperimentale: Loop diuretic + acetazolamide (LD+A)
Intravenous furosemide (as in the LD arm) plus intravenous acetazolamide 500 mg once daily for a maximum of 3 days (maximum 3 administrations). |
Intravenous furosemide; initial dose twice the oral outpatient dose (max 160 mg) or 40 mg if loop diuretic-naïve; subsequent adjustments per attending physician. Intravenous acetazolamide 500 mg once daily for up to 3 days. |
Cosa sta misurando lo studio?
Misure di risultato primarie
Misure di risultato primarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
|---|---|---|
|
Change in spot urinary sodium concentration at 6 hours
Lasso di tempo: Baseline and 6 hours after the first study treatment administration (day 1)
|
Change in spot urinary sodium concentration (mmol/L) from baseline to 6 hours after the first study treatment administration. The main comparison is LD+A versus LD alone; the comparison of LD+SGLT2i versus LD alone is secondary. |
Baseline and 6 hours after the first study treatment administration (day 1)
|
Misure di risultato secondarie
Misure di risultato secondarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
|---|---|---|
|
Change in spot urinary sodium concentration at day 3
Lasso di tempo: Baseline and 6 hours after the third study treatment administration (day 3)
|
Change in spot urinary sodium (mmol/L) from baseline to 6 hours after the third study treatment administration. |
Baseline and 6 hours after the third study treatment administration (day 3)
|
|
Proportion of patients with spot urinary sodium >70 mmol/L
Lasso di tempo: 6 hours after first administration (day 1)
|
Percentage of patients achieving spot urinary sodium >70 mmol/L 6 hours after the first study treatment administration. |
6 hours after first administration (day 1)
|
|
Change in spot urinary potassium
Lasso di tempo: Baseline, 6 hours after first administration (day 1) and 6 hours after third administration (day 3)
|
Change in spot urinary potassium (mmol/L) from baseline. |
Baseline, 6 hours after first administration (day 1) and 6 hours after third administration (day 3)
|
|
Change in spot urinary magnesium
Lasso di tempo: Baseline, 6 hours after first administration (day 1) and 6 hours after third administration (day 3)
|
Change in spot urinary magnesium from baseline. |
Baseline, 6 hours after first administration (day 1) and 6 hours after third administration (day 3)
|
|
Change in spot urinary phosphate
Lasso di tempo: Baseline, 6 hours after first administration (day 1) and 6 hours after third administration (day 3)
|
Change in spot urinary phosphate from baseline. |
Baseline, 6 hours after first administration (day 1) and 6 hours after third administration (day 3)
|
|
Change in estimated glomerular filtration rate (eGFR)
Lasso di tempo: Baseline and day 3
|
Change in eGFR (mL/min/1.73 m²) from baseline. |
Baseline and day 3
|
|
Change in hemoglobin
Lasso di tempo: Baseline and day 3
|
Change in hemoglobin (g/dL) from baseline. |
Baseline and day 3
|
|
Change in hematocrit
Lasso di tempo: Baseline and day 3
|
Change in hematocrit (%) from baseline. |
Baseline and day 3
|
|
Change in serum urea
Lasso di tempo: Baseline and day 3
|
Change in serum urea (mg/dL) from baseline. |
Baseline and day 3
|
|
Change in serum sodium
Lasso di tempo: Baseline and day 3
|
Change in serum sodium (mmol/L) from baseline. |
Baseline and day 3
|
|
Change in serum potassium
Lasso di tempo: Baseline and day 3
|
Change in serum potassium (mmol/L) from baseline. |
Baseline and day 3
|
|
Change in serum chloride
Lasso di tempo: Baseline and day 3
|
Change in serum chloride (mmol/L) from baseline. |
Baseline and day 3
|
|
Change in systolic blood pressure
Lasso di tempo: Baseline, day 2 and day 3
|
Change in systolic blood pressure (mmHg) from baseline. |
Baseline, day 2 and day 3
|
|
Change in diastolic blood pressure
Lasso di tempo: Baseline, day 2 and day 3
|
Change in diastolic blood pressure (mmHg) from baseline. |
Baseline, day 2 and day 3
|
|
Change in clinical congestion score
Lasso di tempo: Baseline, day 2 and day 3
|
Change in the clinical congestion score from baseline. The clinical congestion score is a composite score based on three items (orthopnea, peripheral edema and jugular venous pressure elevation), each graded from 0 to 3, with a total score ranging from 0 (no congestion) to 9 (maximum congestion). Higher scores indicate a worse outcome (more congestion). |
Baseline, day 2 and day 3
|
|
Proportion of patients with clinical decongestion
Lasso di tempo: Day 3
|
Percentage of patients achieving clinical decongestion, defined as a clinical congestion score ≤2 points. The clinical congestion score is a composite score based on orthopnea, peripheral edema and jugular venous pressure elevation, each graded from 0 to 3 (total score 0-9; higher scores indicate more congestion). |
Day 3
|
|
Cumulative intravenous loop diuretic dose
Lasso di tempo: Up to day 3
|
Cumulative intravenous furosemide dose (mg) administered up to day 3. |
Up to day 3
|
|
Incidence of hypokalemia
Lasso di tempo: Baseline to day 3
|
Percentage of patients with serum potassium <3.5 mmol/L. |
Baseline to day 3
|
|
Incidence of severe hypokalemia
Lasso di tempo: Baseline to day 3
|
Percentage of patients with serum potassium <3.0 mmol/L. |
Baseline to day 3
|
|
Incidence of hyponatremia
Lasso di tempo: Baseline to day 3
|
Percentage of patients with serum sodium <135 mmol/L. |
Baseline to day 3
|
|
Incidence of hypotension
Lasso di tempo: Baseline to day 3
|
Percentage of patients with systolic blood pressure <90 mmHg. |
Baseline to day 3
|
|
Incidence of stage 2 acute kidney injury
Lasso di tempo: Baseline to day 3
|
Percentage of patients with stage 2 acute kidney injury according to the Kidney Disease: Improving Global Outcomes (KDIGO) staging criteria, defined as at least doubling of serum creatinine from baseline. KDIGO stages range from 1 to 3, with higher stages indicating more severe kidney injury (worse outcome). |
Baseline to day 3
|
|
Incidence of ≥50% increase in serum creatinine
Lasso di tempo: Baseline to day 3
|
Percentage of patients with ≥50% increase in serum creatinine from baseline. |
Baseline to day 3
|
Altre misure di risultato
Altre misure di risultato
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
|---|---|---|
|
Length of hospital stay
Lasso di tempo: From emergency department admission until hospital discharge, assessed up to 90 days
|
Duration of index hospitalization (days). |
From emergency department admission until hospital discharge, assessed up to 90 days
|
|
In-hospital mortality
Lasso di tempo: From emergency department admission until hospital discharge, assessed up to 90 days
|
Death from any cause during index hospitalization. |
From emergency department admission until hospital discharge, assessed up to 90 days
|
|
All-cause mortality
Lasso di tempo: From study inclusion until death from any cause, assessed up to 90 days
|
Time to death from any cause. |
From study inclusion until death from any cause, assessed up to 90 days
|
|
Cardiovascular mortality
Lasso di tempo: From study inclusion until cardiovascular death, assessed up to 90 days
|
Time to cardiovascular death. |
From study inclusion until cardiovascular death, assessed up to 90 days
|
|
All-cause rehospitalization
Lasso di tempo: From hospital discharge until first rehospitalization for any cause, assessed up to 90 days after study inclusion
|
Time to first rehospitalization for any cause. |
From hospital discharge until first rehospitalization for any cause, assessed up to 90 days after study inclusion
|
|
Heart failure rehospitalization
Lasso di tempo: From hospital discharge until first rehospitalization for heart failure, assessed up to 90 days after study inclusion
|
Time to first rehospitalization for heart failure. |
From hospital discharge until first rehospitalization for heart failure, assessed up to 90 days after study inclusion
|
|
Composite of all-cause mortality or all-cause rehospitalization
Lasso di tempo: From study inclusion until the first occurrence of any component event, assessed up to 90 days
|
Time to first occurrence of all-cause death or all-cause rehospitalization. |
From study inclusion until the first occurrence of any component event, assessed up to 90 days
|
|
Composite of cardiovascular mortality or heart failure rehospitalization
Lasso di tempo: From study inclusion until the first occurrence of any component event, assessed up to 90 days
|
Time to first occurrence of cardiovascular death or heart failure rehospitalization. |
From study inclusion until the first occurrence of any component event, assessed up to 90 days
|
Collaboratori e investigatori
Sponsor
Sponsor
Investigatori
Investigatori
- Investigatore principale: Pedro M. Marques, MD, Unidade Local de Saúde São João, Oporto
Studiare le date dei record
Studia le date principali
Inizio studio (Effettivo)
Inizio studio
Completamento primario (Effettivo)
Completamento primario
Completamento dello studio (Stimato)
Completamento dello studio
Date di iscrizione allo studio
Primo inviato
Primo inviato
Primo inviato che soddisfa i criteri di controllo qualità
Primo inviato che soddisfa i criteri di controllo qualità
Primo Inserito (Effettivo)
Primo Inserito
Aggiornamenti dei record di studio
Ultimo aggiornamento pubblicato (Effettivo)
Ultimo aggiornamento pubblicato
Ultimo aggiornamento inviato che soddisfa i criteri QC
Ultimo aggiornamento inviato che soddisfa i criteri QC
Ultimo verificato
Ultimo verificato
Maggiori informazioni
Termini relativi a questo studio
Termini MeSH pertinenti aggiuntivi
- Malattia cardiovascolare
- Malattie cardiache
- Arresto cardiaco
- Composti di zolfo
- Prodotti chimici organici
- Composti eterociclici, 1-anello
- Composti eterociclici
- Tiazoli
- Azoli
- Amides
- Composti di anilina
- Ammine
- Tiadiazoli
- Sulfonamidi
- Sulfanilamides
- Solfoni
- Acetazolamide
- Furosemide
- empagliflozin
- Dapagliflozin
Altri numeri di identificazione dello studio
Altri numeri di identificazione dello studio
- GLIDE-DHF
Informazioni su farmaci e dispositivi, documenti di studio
Studia un prodotto farmaceutico regolamentato dalla FDA degli Stati Uniti
Studia un dispositivo regolamentato dalla FDA degli Stati Uniti
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