{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T08:06:04Z","timestamp":1791446764532,"version":"4.3.3"},"reference-count":17,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2025,9,16]],"date-time":"2025-09-16T00:00:00Z","timestamp":1757980800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,9,16]],"date-time":"2025-09-16T00:00:00Z","timestamp":1757980800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Overcoming resistance to diuretics is extremely important in decompensated chronic heart failure (HF). The objective of this study was to assess the efficacy and safety of oral acetazolamide, in addition to standard therapy, in HF patients admitted to the hospital with decompensation requiring intravenous loop diuretic therapy. Methods: In this open-label, prospective, multicenter, randomized trial, we included 416 patients hospitalized with decompensated HF. The patients were randomized into two groups: (1) standard therapy, and (2) standard therapy + acetazolamide orally 250 mg 3 times a day in the first 3 days of hospitalization. At randomization, oral thiazide\/thiazide-like and loop diuretics were stopped, and intravenous furosemide was initiated. Results: Successful decongestion within 72 h of randomization was observed in 82 patients (39.6%) in the acetazolamide group and in 83 patients (39.7%) in the standard therapy group (p = 0.983). There was a significant difference in the increase in diuresis in the first 72 h (p = 0.028) and in natriuresis on the 2nd day (p = 0.04). There were no differences between the groups in duration of stay in the intensive care unit, duration of index hospitalization, 6 min walk test distance, and clinical assessment scale scores. Death from any cause occurred in three (1.4%) patients in the acetazolamide group, and in the same number of patients in the standard therapy group (p = 0.996). Death from cardiovascular cause and due to decompensated HF also did not differ between the groups during follow-up. Conclusions: The addition of acetazolamide to standard therapy in decompensated chronic HF resulted in a higher cumulative urine output during the first 72 h and natriuresis on the 2nd day after randomization.<\/jats:p>","DOI":"10.3390\/jcm14186517","type":"journal-article","created":{"date-parts":[[2025,9,16]],"date-time":"2025-09-16T14:31:41Z","timestamp":1758033101000},"page":"6517","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Acetazolamide per os in Decompensated Chronic Heart Failure: Randomized Multicenter Trial ORION-A"],"prefix":"10.3390","volume":"14","author":[{"given":"Ibragim","family":"Sabirov","sequence":"first","affiliation":[{"name":"Department of Therapy \u21162, Interstate Educational Organization of Higher Education Kyrgyz-Russian Slavic University Named After the First President of the Russian Federation B.N. Yeltsin, Bishkek 720000, Kyrgyzstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olesya","family":"Rubanenko","sequence":"additional","affiliation":[{"name":"Department of Hospital Therapy with Courses in Hematology and Transfusiology, Samara State Medical University, Samara 443099, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Svetlana","family":"Villevalde","sequence":"additional","affiliation":[{"name":"Almazov National Medical Research Centre, Saint Petersburg 197341, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anatoly","family":"Rubanenko","sequence":"additional","affiliation":[{"name":"Department of Propaedeutic Therapy with the Course of Cardiology, Samara State Medical University, Samara 443099, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadezhda","family":"Veselovskaya","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Cardiovascular Surgery, Altai State Medical University, Barnaul 656038, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3399-0402","authenticated-orcid":false,"given":"Vitaly","family":"Ivanenko","sequence":"additional","affiliation":[{"name":"Volgograd Regional Clinical Cardiology Center, Volgograd 400008, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalia","family":"Kosheleva","sequence":"additional","affiliation":[{"name":"Department of Hospital Therapy, Saratov State Medical University Named After V.I. Razumovsky, Saratov 410053, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6000-4850","authenticated-orcid":false,"given":"Maksim","family":"Menzorov","sequence":"additional","affiliation":[{"name":"Department of Therapy and Occupational Diseases, Ulyanovsk State University, Ulyanovsk 432017, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilya","family":"Pochinka","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Internal Diseases, Privolzhsky Research Medical University, Nizhny Novgorod 603006, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6516-3180","authenticated-orcid":false,"given":"Konstantin","family":"Protasov","sequence":"additional","affiliation":[{"name":"Russian Medical Academy of Continuing Professional Education, Irkutsk 664049, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niyaz","family":"Khasanov","sequence":"additional","affiliation":[{"name":"Department of Propaedeutics of Internal Diseases Named After Professor S.S. Zimnitsky, Kazan State Medical University, Kazan 420012, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergey","family":"Yakushin","sequence":"additional","affiliation":[{"name":"Department of Hospital Therapy with a Course of Medical and Social Expertise, Ryazan State Medical University, Ryazan 390026, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5130-5192","authenticated-orcid":false,"given":"Elena","family":"Medvedeva","sequence":"additional","affiliation":[{"name":"Almazov National Medical Research Centre, Saint Petersburg 197341, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6453-2976","authenticated-orcid":false,"given":"Dmitry","family":"Duplyakov","sequence":"additional","affiliation":[{"name":"Department of Propaedeutic Therapy with the Course of Cardiology, Samara State Medical University, Samara 443099, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1016\/j.amjcard.2019.05.030","article-title":"The Burden of Congestion in Patients Hospitalized With Acute Decompensated Heart Failure","volume":"124","author":"Cooper","year":"2019","journal-title":"Am. 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Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1415","DOI":"10.1002\/ejhf.1478","article-title":"Acetazolamide to increase natriuresis in congestive heart failure at high risk for diuretic resistance","volume":"21","author":"Verbrugge","year":"2019","journal-title":"Eur. J. Heart Fail."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"3599","DOI":"10.1093\/eurheartj\/ehab368","article-title":"2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure","volume":"42","author":"McDonagh","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"5477","DOI":"10.15829\/1560-4071-2023-5477","article-title":"Efficacy and safety of acetazolamide in patients with NYHA class II\u2013IV decompensated heart failure: Protocol of an open-label prospective randomized multicenter study (ORION-A)","volume":"28","author":"Rubanenko","year":"2023","journal-title":"Russ. J. Cardiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e081123","DOI":"10.1136\/bmj-2024-081123","article-title":"CONSORT 2025 statement: Updated guideline for reporting randomised trials","volume":"389","author":"Hopewell","year":"2025","journal-title":"BMJ"},{"key":"ref_9","unstructured":"World Health Organization (2023). 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Med."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/18\/6517\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T12:24:21Z","timestamp":1763727861000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/18\/6517"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,16]]},"references-count":17,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["jcm14186517"],"URL":"https:\/\/doi.org\/10.3390\/jcm14186517","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,16]]}}}