{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T02:02:58Z","timestamp":1776132178177,"version":"3.50.1"},"reference-count":18,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T00:00:00Z","timestamp":1774224000000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["K23DK128657"],"award-info":[{"award-number":["K23DK128657"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100031470","name":"Spanish Society of Internal Medicine","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100031470","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and hypothesis<\/jats:title>\n                    <jats:p>The association between acute declines in estimated glomerular filtration rate (eGFR) among individuals admitted for acute decompensated heart failure (ADHF) and cardiovascular outcomes has been inconsistent. Our objective was to examine whether eGFR decline and the timing of these declines are associated with mortality and a composite outcome of mortality or heart failure (HF) hospitalization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We used data from the CLOROTIC trial, which randomized patients admitted for ADHF to thiazide versus placebo. We examined % eGFR change at 2 days (n\u00a0=\u00a0225) and at 4 days (n\u00a0=\u00a0218) after randomization. Multivariable Cox models were used to evaluate the association between % eGFR change and a primary outcome of mortality and secondary outcome of composite of mortality or HF hospitalization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Median % eGFR change was -9.7% (IQR -22.1, 5.4) and -14.4% (-25.1, 7.8) in the thiazide arm at 2 and 4 days, respectively, compared to -0.3% (-7.5, 10.1) and 0% (-10.0, 16.2) in the placebo arm at 2 and 4 days, respectively. Over a median 3-month follow-up, of those with 2-day eGFR change available, 41 (18%) patients died and 98 (44%) met the composite outcome, and of those with 4-day eGFR change available, 38 (17.4%) died and 95 (43.6%) met the composite outcome. The eGFR decline at 2 days was not associated with risk of mortality (hazard ratio [HR] = 0.96 [95% CI 0.47, 1.97] and HR = 0.89 [0.37, 2.10] per 30% eGFR decline in the thiazide and placebo arms, respectively). The eGFR decline at 4 days was not associated with risk of mortality in the thiazide arm (HR\u00a0=\u00a00.86 [0.48, 1.55] per 30% eGFR decline) nor in the placebo (HR\u00a0=\u00a01.63 [0.82, 3.26] per 30% eGFR decline). Associations were similar for the composite outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Among patients admitted for ADHF and randomized to thiazide versus placebo, early acute declines in eGFR had no association with increased risk of cardiovascular outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Registration<\/jats:title>\n                    <jats:p>Clinicaltrials.gov: NCT01647932; EudraCT Number: 2013-001852-36.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ndt\/gfag070","type":"journal-article","created":{"date-parts":[[2026,3,21]],"date-time":"2026-03-21T12:36:13Z","timestamp":1774096573000},"source":"Crossref","is-referenced-by-count":0,"title":["Acute declines in kidney function with thiazide plus loop diuretics versus loop diuretics alone in acute decompensated heart failure"],"prefix":"10.1093","author":[{"given":"Wendy","family":"McCallum","sequence":"first","affiliation":[{"name":"Division of Nephrology, Tufts Medical Center , Boston, MA ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hocine","family":"Tighiouart","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Tufts Medical Center , Boston, MA ,","place":["USA"]},{"name":"Institute for Clinical Research and Health Policy Studies, Tufts Medical Center , Boston, MA ,","place":["USA"]},{"name":"Tufts Clinical and Translational Science Institute, Tufts University , Boston, MA ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marcelle","family":"Tuttle","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Tufts Medical Center , Boston, MA ,","place":["USA"]},{"name":"Tufts Clinical and Translational Science Institute, Tufts University , Boston, MA, \u00a0","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tatsufumi","family":"Oka","sequence":"additional","affiliation":[{"name":"Osaka University Graduate School of Medicine Department of Nephrology, , Suita, \u00a0","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tavleen","family":"Kaur","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Tufts Medical Center , Boston, MA ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jes\u00fas","family":"Casado","sequence":"additional","affiliation":[{"name":"Hospital Universitario de Getafe Internal Medicine Department, , Getafe, Madrid, \u00a0","place":["Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jose Lu\u00eds","family":"Morales-Rull","sequence":"additional","affiliation":[{"name":"Hospital Universitari Arnau de Villanova, Institut de Recerca Biom\u00e9dica (IRBLleida) Heart Failure Unit, Internal Medicine Department, , Lleida ,","place":["Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3587-298X","authenticated-orcid":false,"given":"Francesc","family":"Formiga","sequence":"additional","affiliation":[{"name":"Hospital Universitari de Bellvitge, IDIBELL, L\u2019Hospitalet de Llobregat Internal Medicine Department, , Barcelona ,","place":["Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lu\u00eds","family":"Manzano","sequence":"additional","affiliation":[{"name":"Hospital Universitario Ram\u00f3n y Cajal, IRYCIS, Universidad de Alcal\u00e1 Internal Medicine Department, , Madrid ,","place":["Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey M","family":"Testani","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Yale School of Medicine , New Haven, CT ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark J","family":"Sarnak","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Tufts Medical Center , Boston, MA ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joan Carles","family":"Trull\u00e1s","sequence":"additional","affiliation":[{"name":"Hospital d\u2019Olot i comarcal de la Garrotxa Internal Medicine Department, , Girona ,","place":["Spain"]},{"name":"Tissue Repair and Regeneration Laboratory (TR2Lab), Faculty of Medicine, University of Vic-Central University of Catalonia (Uvic-UCC) , Vic, Barcelona ,","place":["Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2026,3,23]]},"reference":[{"key":"2026041321270598700_bib1","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1002\/ejhf.1369","article-title":"The use of diuretics in heart failure with congestion\u2014a position statement from the Heart Failure Association of the European Society of 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