Not a perfect comparison but interesting nonetheless. Augmented UOP with the intervention vs placebo in CLOROTIC, EMPAG-HF and ADVOR
HCTZ: 26%
Empagliflozin: 25%
Acetazolamide: 12%
HCTZ: 26%
Empagliflozin: 25%
Acetazolamide: 12%
February 19, 2025 at 9:08 PM
Not a perfect comparison but interesting nonetheless. Augmented UOP with the intervention vs placebo in CLOROTIC, EMPAG-HF and ADVOR
HCTZ: 26%
Empagliflozin: 25%
Acetazolamide: 12%
HCTZ: 26%
Empagliflozin: 25%
Acetazolamide: 12%
Nice thread and then discussion on ADVOR, fully agree.
I'm a big fan of sequential nephron blockade, including diamox, which I have used successfully many times. But as a reminder, the VAST majority of patients w/ADHF can be successfully decongested with adequate loop diuretic doses and adding thiazides when necessary #medsky #cardiosky
November 19, 2024 at 7:35 AM
Nice thread and then discussion on ADVOR, fully agree.
Remember the biggest criticism of ADVOR was the decongestion score, though ultimately it was a positive trial. However, patients taking >80mg of furosemide equivalents prior to enrollment were excluded therefore this is not a population of diuretic resistant patients, depending on your definition
November 18, 2024 at 11:39 PM
Remember the biggest criticism of ADVOR was the decongestion score, though ultimately it was a positive trial. However, patients taking >80mg of furosemide equivalents prior to enrollment were excluded therefore this is not a population of diuretic resistant patients, depending on your definition
Then it's backed up by the ADVOR trial. I don't think it's terribly effective as a diuretic, but it is great at correcting alkalosis in that setting. www.nejm.org/doi/full/10....
Acetazolamide in Acute Decompensated Heart Failure with Volume Overload | NEJM
Whether acetazolamide, a carbonic anhydrase inhibitor that reduces proximal tubular sodium reabsorption, can improve the efficiency of loop diuretics, potentially leading to more and faster deconge...
www.nejm.org
February 12, 2026 at 9:30 PM
Then it's backed up by the ADVOR trial. I don't think it's terribly effective as a diuretic, but it is great at correcting alkalosis in that setting. www.nejm.org/doi/full/10....
Renal Function and Decongestion with ADHF: the ADVOR Trial - The Hospitalist - goo.gl/alerts/PbVdnj #GoogleAlerts
Renal Function and Decongestion with ADHF: the ADVOR Trial - The Hospitalist
Does acetazolamide enhance loop diuretic effect in patients with acute decompensated heart failure (ADHF) and how does this combination affect renal function?
goo.gl
March 5, 2025 at 12:41 AM
Renal Function and Decongestion with ADHF: the ADVOR Trial - The Hospitalist - goo.gl/alerts/PbVdnj #GoogleAlerts
How 2 advor-tize things? :o
a cartoon of spongebob making a funny face
ALT: a cartoon of spongebob making a funny face
media.tenor.com
November 5, 2025 at 8:41 PM
How 2 advor-tize things? :o
48h UOP in ADVOR was ~4.5L when combined with bumetanide. In CARRESS the median furosemide dose was 120mg prior to enrollment.
November 18, 2024 at 11:39 PM
48h UOP in ADVOR was ~4.5L when combined with bumetanide. In CARRESS the median furosemide dose was 120mg prior to enrollment.
😂
Max out loops, add a thiazide, amiloride +/- diamox (remember ADVOR tolerated a bicarb down to 12, although clearly more effective if serum bicarb >27). Need to make sure flow appropriate - don’t forget RPP, ascites, etc.
THEN 150cc of 3% BID x 48h or more followed by UF + a palliative consult
Max out loops, add a thiazide, amiloride +/- diamox (remember ADVOR tolerated a bicarb down to 12, although clearly more effective if serum bicarb >27). Need to make sure flow appropriate - don’t forget RPP, ascites, etc.
THEN 150cc of 3% BID x 48h or more followed by UF + a palliative consult
November 25, 2024 at 6:41 PM
😂
Max out loops, add a thiazide, amiloride +/- diamox (remember ADVOR tolerated a bicarb down to 12, although clearly more effective if serum bicarb >27). Need to make sure flow appropriate - don’t forget RPP, ascites, etc.
THEN 150cc of 3% BID x 48h or more followed by UF + a palliative consult
Max out loops, add a thiazide, amiloride +/- diamox (remember ADVOR tolerated a bicarb down to 12, although clearly more effective if serum bicarb >27). Need to make sure flow appropriate - don’t forget RPP, ascites, etc.
THEN 150cc of 3% BID x 48h or more followed by UF + a palliative consult
Treating congested HF patient is really the lions share of hospital doctors work. I’ve been quite disappointed that trials have tested a trillion platelet inhibition schemes but very little decongestion strategies (except ADVOR). So hell yeah!
January 17, 2026 at 5:23 PM
Treating congested HF patient is really the lions share of hospital doctors work. I’ve been quite disappointed that trials have tested a trillion platelet inhibition schemes but very little decongestion strategies (except ADVOR). So hell yeah!
IV diuretics are not just “more Lasix.”
They are threshold drugs, delivery drugs, and nephron segment tools.
New Nephrology Notebook lecture: 2 hour urine sodium, DOSE, ADVOR, CLICK, cirrhosis, nephrotic edema, and when NOT to diurese.
youtu.be/z30l6o12MlA?...
They are threshold drugs, delivery drugs, and nephron segment tools.
New Nephrology Notebook lecture: 2 hour urine sodium, DOSE, ADVOR, CLICK, cirrhosis, nephrotic edema, and when NOT to diurese.
youtu.be/z30l6o12MlA?...
IV Diuretics Deep Dive: From Loop Threshold to Sequential Nephron Blockade
YouTube video by Nephrology Notebook
youtu.be
July 2, 2026 at 12:43 AM
IV diuretics are not just “more Lasix.”
They are threshold drugs, delivery drugs, and nephron segment tools.
New Nephrology Notebook lecture: 2 hour urine sodium, DOSE, ADVOR, CLICK, cirrhosis, nephrotic edema, and when NOT to diurese.
youtu.be/z30l6o12MlA?...
They are threshold drugs, delivery drugs, and nephron segment tools.
New Nephrology Notebook lecture: 2 hour urine sodium, DOSE, ADVOR, CLICK, cirrhosis, nephrotic edema, and when NOT to diurese.
youtu.be/z30l6o12MlA?...
Comparing results with CARRESS. Less diuresis in ADVOR. Nice study in JACC in which patients on GDMT were given lasix+metolazone, lasix alone or with acetazolamide. Not the furosemide doses. Metolazone wins this battle. Higher creatinine with metolazone but who cares
November 16, 2024 at 10:51 AM
Comparing results with CARRESS. Less diuresis in ADVOR. Nice study in JACC in which patients on GDMT were given lasix+metolazone, lasix alone or with acetazolamide. Not the furosemide doses. Metolazone wins this battle. Higher creatinine with metolazone but who cares
ADVOR :
Acute decompensated heart failure
One sign of congestion
On loop diuretics
SGLT2 were excluded
Day 1 every g receives bumetanide 2x home dose with 500 mg of acetazolamide
After that they were randomized to acetazolamide or placebo in addition to bumetanide
Acute decompensated heart failure
One sign of congestion
On loop diuretics
SGLT2 were excluded
Day 1 every g receives bumetanide 2x home dose with 500 mg of acetazolamide
After that they were randomized to acetazolamide or placebo in addition to bumetanide
November 23, 2024 at 1:22 PM
ADVOR :
Acute decompensated heart failure
One sign of congestion
On loop diuretics
SGLT2 were excluded
Day 1 every g receives bumetanide 2x home dose with 500 mg of acetazolamide
After that they were randomized to acetazolamide or placebo in addition to bumetanide
Acute decompensated heart failure
One sign of congestion
On loop diuretics
SGLT2 were excluded
Day 1 every g receives bumetanide 2x home dose with 500 mg of acetazolamide
After that they were randomized to acetazolamide or placebo in addition to bumetanide
Loop diuretics are the standard, but resistance is common. Can adding Acetazolamide unlock the kidneys?
doi.org/10.7759/cureus.75778
#WeiPublications #CardioSky #HeartFailure #MedSky #Cardiology #Diuretics #ADVOR #FOAMed
doi.org/10.7759/cureus.75778
#WeiPublications #CardioSky #HeartFailure #MedSky #Cardiology #Diuretics #ADVOR #FOAMed
Effectiveness of Acetazolamide in Patients With Heart Failure: A Systematic Review and Meta-Analysis
This systematic review and meta-analysis evaluated the efficacy and safety of acetazolamide as an adjunctive diuretic therapy in acute heart failure (AHF) patients. A comprehensive literature search w...
doi.org
January 3, 2026 at 10:22 PM
Loop diuretics are the standard, but resistance is common. Can adding Acetazolamide unlock the kidneys?
doi.org/10.7759/cureus.75778
#WeiPublications #CardioSky #HeartFailure #MedSky #Cardiology #Diuretics #ADVOR #FOAMed
doi.org/10.7759/cureus.75778
#WeiPublications #CardioSky #HeartFailure #MedSky #Cardiology #Diuretics #ADVOR #FOAMed
#artfight2026 Attack no.2 - Advor by Zeff_
I have a few characters bookmarked but I rolled random and saw this.. and go yesss... I like the edge... time to draw...
I have a few characters bookmarked but I rolled random and saw this.. and go yesss... I like the edge... time to draw...
July 6, 2026 at 5:24 AM
#artfight2026 Attack no.2 - Advor by Zeff_
I have a few characters bookmarked but I rolled random and saw this.. and go yesss... I like the edge... time to draw...
I have a few characters bookmarked but I rolled random and saw this.. and go yesss... I like the edge... time to draw...
I did not (not on day 1, at least). Even though ADVOR reported zero cases of severe metab acidosis, this was defined as HCO3 <12. My patient had a bicarb of 19 and mixed resp/metab acidosis, so I thought that further decrease of HCO3 by acetazolamide would make her more acidotic
November 18, 2024 at 7:26 PM
I did not (not on day 1, at least). Even though ADVOR reported zero cases of severe metab acidosis, this was defined as HCO3 <12. My patient had a bicarb of 19 and mixed resp/metab acidosis, so I thought that further decrease of HCO3 by acetazolamide would make her more acidotic
The ADVOR trial (N Engl J Med 2022; 387: 1185-1195
DOI: 10.1056/NEJMoa2203094) has showed that the addition of acetazolamide to a loop diuretic in pts with acute decompensated heart failure results in a greater incidence of successful decongestion. Would you give it here?
DOI: 10.1056/NEJMoa2203094) has showed that the addition of acetazolamide to a loop diuretic in pts with acute decompensated heart failure results in a greater incidence of successful decongestion. Would you give it here?
November 18, 2024 at 7:02 PM
The ADVOR trial (N Engl J Med 2022; 387: 1185-1195
DOI: 10.1056/NEJMoa2203094) has showed that the addition of acetazolamide to a loop diuretic in pts with acute decompensated heart failure results in a greater incidence of successful decongestion. Would you give it here?
DOI: 10.1056/NEJMoa2203094) has showed that the addition of acetazolamide to a loop diuretic in pts with acute decompensated heart failure results in a greater incidence of successful decongestion. Would you give it here?
Acetazolamide (Diamox) is a carbonic anhydrase inhibitor traditionally used for the management of acute angle-closure glaucoma & idiopathic intracranial hypertension. It became more popular recently after the publication of ADVOR trial in NEJM where its addition to loop diuretics
November 17, 2024 at 12:17 AM
Acetazolamide (Diamox) is a carbonic anhydrase inhibitor traditionally used for the management of acute angle-closure glaucoma & idiopathic intracranial hypertension. It became more popular recently after the publication of ADVOR trial in NEJM where its addition to loop diuretics
The long awaited #advor trial was published. Acetazolamide added to loop diuretics significantly improved decongestion at 3 days (primary endpoint) v placebo in ADHF
Big time study affirming our practice @UWNephrology. Now let’s do diamox v...
Big time study affirming our practice @UWNephrology. Now let’s do diamox v...
November 16, 2024 at 11:16 PM
The long awaited #advor trial was published. Acetazolamide added to loop diuretics significantly improved decongestion at 3 days (primary endpoint) v placebo in ADHF
Big time study affirming our practice @UWNephrology. Now let’s do diamox v...
Big time study affirming our practice @UWNephrology. Now let’s do diamox v...
Diuretic management in decompensated heart failure has been stagnant for years but recently we have some new tools to help us out.
Let's review the Rise of the Proximal Tubule Inhibitors in preparation for the #nephjc discussion on ADVOR tonight.
#MedTwitter @MedTweetorials
Let's review the Rise of the Proximal Tubule Inhibitors in preparation for the #nephjc discussion on ADVOR tonight.
#MedTwitter @MedTweetorials
November 16, 2024 at 11:16 PM
Diuretic management in decompensated heart failure has been stagnant for years but recently we have some new tools to help us out.
Let's review the Rise of the Proximal Tubule Inhibitors in preparation for the #nephjc discussion on ADVOR tonight.
#MedTwitter @MedTweetorials
Let's review the Rise of the Proximal Tubule Inhibitors in preparation for the #nephjc discussion on ADVOR tonight.
#MedTwitter @MedTweetorials
The CLOROTIC trial showing efficacy of thiazides - but again this was upfront therapy (similar to acetazolamide in ADVOR) and not specifically for diuretic resistance #kidneywk
November 16, 2024 at 9:43 PM
The CLOROTIC trial showing efficacy of thiazides - but again this was upfront therapy (similar to acetazolamide in ADVOR) and not specifically for diuretic resistance #kidneywk
Hard to compare this with ADVOR as the populations differed (look at furosemide equivalents at baseline). As w/other trials this is up-front therapy and not technically diuretic resistance though these patients were on much higher outpatient furosemide equivalent doses.
November 16, 2024 at 8:19 PM
Hard to compare this with ADVOR as the populations differed (look at furosemide equivalents at baseline). As w/other trials this is up-front therapy and not technically diuretic resistance though these patients were on much higher outpatient furosemide equivalent doses.
Seems ADVOR got more fanfare than CLOROTIC, published last month.
Smaller trial, double blind, placebo-control, HCTZ vs placebo added on to furosemide as initial therapy for ADHF
🔥⬆️weight loss, diuresis, natriuresis w/HCTZ
🚫change in VAS score
🚫improv. diuretic efficiency
Smaller trial, double blind, placebo-control, HCTZ vs placebo added on to furosemide as initial therapy for ADHF
🔥⬆️weight loss, diuresis, natriuresis w/HCTZ
🚫change in VAS score
🚫improv. diuretic efficiency
November 16, 2024 at 8:00 PM
Seems ADVOR got more fanfare than CLOROTIC, published last month.
Smaller trial, double blind, placebo-control, HCTZ vs placebo added on to furosemide as initial therapy for ADHF
🔥⬆️weight loss, diuresis, natriuresis w/HCTZ
🚫change in VAS score
🚫improv. diuretic efficiency
Smaller trial, double blind, placebo-control, HCTZ vs placebo added on to furosemide as initial therapy for ADHF
🔥⬆️weight loss, diuresis, natriuresis w/HCTZ
🚫change in VAS score
🚫improv. diuretic efficiency
I typically use a UNa>70 as a target for appropriate natriuresis. Based on this assessment of the ADVOR trial maybe I need to be more aggressive? UNa>80 was associated with reduced mortality and hospitalization....
November 16, 2024 at 6:40 PM
I typically use a UNa>70 as a target for appropriate natriuresis. Based on this assessment of the ADVOR trial maybe I need to be more aggressive? UNa>80 was associated with reduced mortality and hospitalization....
Important post-hoc data of ADVOR showing effective diuresis across bicarbonate levels but more effective if serum bicarbonate >27
November 16, 2024 at 10:59 AM
Important post-hoc data of ADVOR showing effective diuresis across bicarbonate levels but more effective if serum bicarbonate >27