Acetazolamide Therapy in Patients with Heart Failure: A Meta-Analysis

Abstract

Background and objectives: Fluid overload and central sleep apnea are highly prevalent in patients with heart failure (HF). We performed this meta-analysis to assess the effects of acetazolamide therapy on acid/base balance and apnea indexes. Methods: A literature search was conducted using EMBASE, MEDLINE, and Cochrane Database from inception through 18 November 2017 to identify studies evaluating the use of acetazolamide in HF. Study results were analyzed using a random effects model. The protocol for this systematic review is registered with PROSPERO (International Prospective Register of Systematic Reviews; no. CRD42017065401). Results: Nine studies (three randomized controlled trials and six cohort studies) with a total of 229 HF patients were enrolled. After acetazolamide treatment, there were significant decreases in serum pH (mean difference (MD) of −0.04 (95% CI, −0.06 to −0.02)), pCO2 (MD of −2.06 mmHg (95% CI, −3.60 to −0.53 mmHg)), and serum bicarbonate levels (MD of −6.42 mmol/L (95% CI, −10.05 to −2.79 mmol/L)). When compared to a placebo, acetazolamide significantly increased natriuresis (standardized mean difference (SMD) of 0.67 (95% CI, 0.08 to 1.27)), and decreased the apnea-hypopnea index (AHI) (SMD of −1.06 (95% CI, −1.75 to −0.36)) and central apnea index (CAI) (SMD of −1.10 (95% CI, −1.80 to −0.40)). Egger’s regression asymmetry tests revealed no publication bias with p = 0.20, 0.75 and 0.59 for analysis of the changes in pH, pCO2, and serum bicarbonate levels with use of acetazolamide in HF patients. Conclusion: Our study demonstrates significant reduction in serum pH, increase in natriuresis, and improvements in apnea indexes with use of acetazolamide among HF patients.

Nutrients Intake in Individuals with Hypertension, Dyslipidemia, and Diabetes: An Italian Survey

“…It was hypothesized that high BMI might be associated with high salt intake due to a greater food and calories consumption. As calories intake is slightly reduced in our hypertensive population, the diuretic treatment for hypertension might have increased sodium excretion [19].…”

Promises of Big Data and Artificial Intelligence in Nephrology and Transplantation

“…Those needs that are classified as unmet require provision of some ample spaces for the purpose of imagination in relation to leveraging the strength associated with big data, as well as relevant artificial intelligence (AI) to improve the overall status of patients with kidney diseases [25]. In this article, we discuss the big data concepts in nephrology, describe the potential use of AI in nephrology and transplantation, and also encourage researchers and clinicians to submit their invaluable research, including original clinical research studies [26][27][28][29][30], database studies from registries [31][32][33], meta-analyses [34][35][36][37][38][39][40][41][42][43][44], and artificial intelligence research [25,[45][46][47][48] in nephrology and transplantation. Table 1 demonstrates known and commonly used databases that have provided big data in nephrology and transplantation [49][50][51].…”

Targeting Aquaporins in Novel Therapies for Male and Female Breast and Reproductive Cancers

“…An expanding array of pharmacological modulators of aquaporins include methylurea compounds [ 170 ], organic metal compounds [ 171 , 172 , 173 ], bumetanide derivatives and other arylsulfonamides [ 71 , 174 , 175 , 176 ], tetraethylammonium [ 177 , 178 , 179 ], and alternative medicinal constituents [ 180 , 181 ]. The diuretic acetazolamide, an antagonist of carbonic anhydrase approved for treatment of an array of diseases including heart failure [ 182 ], has been proposed to reduce AQP1 activity [ 183 ]. Acetazolamide reduced angiogenesis, tumor growth, and tumor invasion in the Lewis lung carcinoma mouse model [ 184 ], effects consistent with possible AQP1 downregulation [ 183 , 185 ], although other contributing mechanisms of action need to be considered [ 186 ].…”