{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T02:38:47Z","timestamp":1792291127442,"version":"4.4.0"},"reference-count":44,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2015,3,26]],"date-time":"2015-03-26T00:00:00Z","timestamp":1427328000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cardiovascular Therapeutics"],"published-print":{"date-parts":[[2015,4]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Aims<\/jats:title><jats:p>Sequential nephron blockade with thiazide\u2010like diuretics is a strategy used to overcome diuretic resistance in acute decompensated heart failure (<jats:styled-content style=\"fixed-case\">ADHF<\/jats:styled-content>), but head\u2010to\u2010head studies are lacking and equipoise exists regarding the preferred thiazide\u2010like diuretic in this setting. We thus compared the effectiveness of oral metolazone versus intravenous (<jats:styled-content style=\"fixed-case\">IV<\/jats:styled-content>) chlorothiazide as add\u2010on therapy to loop diuretics in hospitalized patients with <jats:styled-content style=\"fixed-case\">ADHF<\/jats:styled-content> and renal dysfunction.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This retrospective cohort study evaluated the efficacy and safety of oral metolazone versus <jats:styled-content style=\"fixed-case\">IV<\/jats:styled-content> chlorothiazide as add\u2010on therapy to loop diuretics in patients hospitalized with <jats:styled-content style=\"fixed-case\">ADHF<\/jats:styled-content> and renal dysfunction. The primary endpoint was net urine output (<jats:styled-content style=\"fixed-case\">UOP<\/jats:styled-content>) at 72\u00a0h after initiation of thiazide\u2010like diuretics. Safety endpoints included worsening renal function, hypotension, and electrolyte abnormalities.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Fifty\u2010five patients were enrolled with 33 patients receiving metolazone and 22 patients receiving chlorothiazide. There was no difference in median net <jats:styled-content style=\"fixed-case\">UOP<\/jats:styled-content> at 72\u00a0h in those receiving metolazone (4828\u00a0mL, interquartile range [<jats:styled-content style=\"fixed-case\">IQR<\/jats:styled-content>] 2800\u20137209\u00a0mL) compared to chlorothiazide (3779\u00a0mL, <jats:styled-content style=\"fixed-case\">IQR<\/jats:styled-content> 1885\u20136535\u00a0mL) (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.16). There was no difference in hypotension, worsening renal function, hyponatremia, or hypokalemia (<jats:italic>P<\/jats:italic>\u00a0=\u00a0<jats:styled-content style=\"fixed-case\">NS<\/jats:styled-content> for all comparisons). Hospital length of stay was shorter in the metolazone cohort (median 7\u00a0days) compared to chlorothiazide (median 15\u00a0days), suggesting the chlorothiazide cohort was likely sicker.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Sequential nephron blockade with either metolazone or chlorothiazide appears to be efficacious and safe in <jats:styled-content style=\"fixed-case\">ADHF<\/jats:styled-content>, renal dysfunction, and diuretic resistance. Given the considerable cost difference favoring oral metolazone, larger randomized studies are warranted to confirm our findings and to exclude the possibility of confounding by indication.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1755-5922.12109","type":"journal-article","created":{"date-parts":[[2015,2,25]],"date-time":"2015-02-25T11:23:07Z","timestamp":1424863387000},"page":"42-49","source":"Crossref","is-referenced-by-count":37,"title":["Comparison of Metolazone Versus Chlorothiazide in Acute Decompensated Heart Failure with Diuretic Resistance"],"prefix":"10.1111","volume":"33","author":[{"given":"Michael P.","family":"Moranville","sequence":"first","affiliation":[{"name":"Department of Pharmacy Johns Hopkins Hospital Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suji","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Pharmacy University of Chicago Medical Center Chicago IL 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