{"id":"52d9f1164ad8","type":"article","url":"https://hartvaat.nl/2023/02/01/clorotic-thiazide-toevoegen-aan-lisdiureticum-bij-acuut-hartfalen/","title":"CLOROTIC: thiazide toevoegen aan lisdiureticum bij acuut hartfalen","title_en":"Combining loop with thiazide diuretics for decompensated heart failure: the CLOROTIC trial.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","internist"],"tags":["diuretica","furosemide"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehac689","source_url":"https://doi.org/10.1093/eurheartj/ehac689","authors":["Joan Carles Trullàs","José Luis Morales-Rull","Jesús Casado","Margarita Carrera-Izquierdo","Marta Sánchez-Marteles","Alicia Conde-Martel","Melitón Francisco Dávila-Ramos","Pau Llácer","Prado Salamanca-Bautista","José Pérez-Silvestre","Miguel Ángel Plasín","José Manuel Cerqueiro","Paloma Gil","Francesc Formiga","Luis Manzano"],"significance":8,"published":"2023-02-01","source_date":"2023-02-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/digoxine-bij-hartfalen/","https://hartvaat.nl/kennis/farmacologie/lisdiuretica-furosemide-bumetanide/"],"congress":"","summary_en":"The CLOROTIC trial showed that adding hydrochlorothiazide to furosemide in acute decompensated heart failure improved weight loss and urine output compared with furosemide alone, though it did not affect dyspnea or all-cause mortality. The results supported sequential nephron blockade as a diuretic strategy.","created":"2026-07-03T10:30:13Z","updated":"2026-07-03T13:29:17Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De CLOROTIC-trial toonde dat toevoeging van hydrochloorthiazide aan furosemide bij acuut hartfalen het gewichtsverlies en de urine-output verbeterde, ten koste van meer elektrolytstoornissen. Combinatiediurese is effectief maar vereist nauwkeurige monitoring.","abstract_original":"AIMS: To evaluate whether the addition of hydrochlorothiazide (HCTZ) to intravenous furosemide is a safe and effective strategy for improving diuretic response in acute heart failure (AHF). METHODS AND RESULTS: A prospective, double-blind, placebo-controlled trial, including patients with AHF randomized to receive HCTZ or placebo in addition to an intravenous furosemide regimen. The coprimary endpoints were changes in body weight and patient-reported dyspnoea 72 h after randomization. Secondary outcomes included metrics of diuretic response and mortality/rehospitalizations at 30 and 90 days. Safety outcomes (changes in renal function and/or electrolytes) were also assessed. Two hundred and thirty patients (48 women, 83 years) were randomized. Patients assigned to HCTZ were more likely to lose weight at 72 h than those assigned to placebo [2.3 vs. 1.5 kg; adjusted estimated difference (notionally 95 confidence interval) 1.14 (1.84 to 0.42); P 0.002], but there were no significant differences in patient-reported dyspnoea (area under the curve for visual analogue scale: 960 vs. 720; P 0.497). These results were similar 96 h after randomization. Patients allocated to HCTZ showed greater 24 h diuresis (1775 vs. 1400 mL; P 0.05) and weight loss for each 40 mg of furosemide (at 72 and at 96 h) (P 0.001). Patients assigned to HCTZ more frequently presented impaired renal function (increase in creatinine 26.5 moL/L or decrease in eGFR 50; 46.5 vs. 17.2; P 0.001), but hypokalaemia and hypokalaemia were similar between groups. There were no differences in mortality or rehospitalizations. CONCLUSION: The addition of HCTZ to loop diuretic therapy improved diuretic response in patients with AHF."}