Natriuresis With Acetazolamide or SGLT2 Inhibitors Added to Intravenous 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.

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 \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) \