Diuretic Resistance in Heart Failure

Rahman, Rubayat; Paz, Pablo; Elmassry, Mohamed; Mantilla, Barbara; Dobbe, Logan; Shurmur, Scott; Nugent, Kenneth

doi:10.1097/crd.0000000000000310

Cited by 14 publications

(20 citation statements)

References 117 publications

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“…Diuretic resistance may exist among some patients, this term, however, does not have a well-accepted definition so far. [ 2 ]…”

Section: Discussionmentioning

confidence: 99%

“…[ 1 ] Loop diuretics have been recognized as a cornerstone in relieving severe fluid accumulation. [ 2 ] However, it remains some shortcomings, such as diuretic resistance and renal dysfunction. [ 2 , 3 ]…”

Section: Introductionmentioning

confidence: 99%

“…[ 2 ] However, it remains some shortcomings, such as diuretic resistance and renal dysfunction. [ 2 , 3 ]…”

Section: Introductionmentioning

confidence: 99%

“…[2] However, it remains some shortcomings, such as diuretic resistance and renal dysfunction. [2,3] Ultrafiltration (UF) is a distinctive way to selectively remove excessive fluid without affecting circulating volume and activating neuro-humoral reaction. [4] The recommendations of ultrafiltration in the ACC/AHA guidelines indicate that UF should be considered for patients with obvious volume overload (Class IIb, Level of Evidence: B) and intractable congestion not responding to medical therapy (Class IIb, Level of Evidence: C).…”

Section: Introductionmentioning

confidence: 99%

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Ultrafiltration for patients with acute decompensated heart failure

Wang

Zheng²,

Jin³

2021

Medicine

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Background: Ultrafiltration plays an indispensable role in relieving congestion and fluid retention in patients with acute decompensated heart failure (ADHF) in recent years. So far, there is no consistent agreement about whether early ultrafiltration (UF) is a first-line treatment for patients with ADHF. We, therefore, conducted a meta-analysis to assess the efficacy and safety of UF. Methods: PubMed, Embase, and Cochrane Library databases were searched for randomized controlled trials (RCTs) that compared UF with diuretics in patients with ADHF and included our interested outcomes. The primary outcomes are heart failure rehospitalization, all-cause rehospitalization, and mortality. The second outcomes are fluid loss, weight loss, and adverse events. RevMan Version 5.4.1 was used to analyze the data of included studies. Results: A total of 12 studies with 1197 patients were included. Our results showed a reduction in heart failure rehospitalization (risk ratio [RR] 0.67, 95% confidence interval [CI]: 0.52–0.87, P = .003) and all-cause rehospitalization (RR 0.62, 95% CI: 0.42–0.92; P = .02), an increase in fluid loss (1.47 L, 95% CI: 0.95–1.99 L, P < .001) and weight loss (1.65 kg, 95% CI: 0.90–2.41 kg; P < .001). There was no difference in mortality (RR 1.09, 95% CI: 0.78–1.51; P = .62). There were inconsistent agreements about which group have more total adverse events. Subgroup analysis showed that UF with larger mean fluid-remove rate (≥200 mL/h) could significantly remove more fluid, lose more weight, and decrease heart failure rehospitalization. Less weight loss for patients with ADHF may correlated to higher percent of ischemic etiology (ischemic etiology ≥50%). Conclusion: Although UF is more effective in removing fluid than diuretics and decrease rehospitalization of heart failure and all causes, there is not enough evidence to prove that UF is superior because of adverse events and mortality in the UF group. The mean fluid-removal rates should be set to ≥200 mL/h. Patient with different etiology may have different effects when treated with UF and it is a weak conclusion. Trial registration: The systematic review was registered with the International Prospective Registry of Systematic Reviews. ( https://www.crd.york.ac.uk/prospero/ , registration number CRD42021245049).

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“…Diuretic resistance may exist among some patients, this term, however, does not have a well-accepted definition so far. [ 2 ]…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…[ 2 ] However, it remains some shortcomings, such as diuretic resistance and renal dysfunction. [ 2 , 3 ]…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Ultrafiltration for patients with acute decompensated heart failure

Wang

Zheng²,

Jin³

2021

Medicine

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show abstract

“…The multiple underlying factors include changes in drug pharmacokinetics, hormonal dysregulation, and the cardiorenal syndrome. The management of patients with diuretic resistance includes sequential nephron blockade using diuretics from two different classes, renal replacement therapy by ultrafiltration or peritoneal dialysis, and aspiration of peritoneal fluid in patients with increased intraabdominal pressure [33]. However, the most commonly used approach is to increase the doses of diuretics drugs to promote a negative fluid and sodium balance.…”

Section: Renal Function and Loop Diureticsmentioning

confidence: 99%

Miejsce diuretyków pętlowych w leczeniu ostrej niewydolności serca

Brycht

Dróżdż

2021

Folia Cardiologica

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The added value of hypertonic saline solution to furosemide monotherapy in patients with acute decompensated heart failure: A meta‐analysis and trial sequential analysis

Diaz‐Arocutipa

Denegri-Galvan

Vicent

et al. 2023

Clinical Cardiology

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We assessed the effects of hypertonic saline solution (HSS) plus furosemide versus furosemide alone in patients with acute decompensated heart failure (ADHF). We searched four electronic databases for randomized controlled trials (RCTs) until June 30, 2022. The quality of evidence (QoE) was assessed using the GRADE approach. All meta‐analyses were performed using a random‐effects model. A trial sequential analysis (TSA) was also conducted for intermediate and biomarker outcomes. Ten RCTs involving 3013 patients were included. HSS plus furosemide significantly reduced the length of hospital stay (mean difference [MD]: −3.60 days; 95% confidence interval [CI]: −4.56 to −2.64; QoE: moderate), weight (MD: −2.34 kg; 95% CI: −3.15 to −1.53; QoE: moderate), serum creatinine (MD: −0.41 mg/dL; 95% CI: −0.49 to −0.33; QoE: low), and type‐B natriuretic peptide (MD: −124.26 pg/mL; 95% CI: −207.97 to −40.54; QoE: low) compared to furosemide alone. HSS plus furosemide significantly increased urine output (MD: 528.57 mL/24 h; 95% CI: 431.90 to 625.23; QoE: moderate), serum Na+ (MD: 6.80 mmol/L; 95% CI: 4.92 to 8.69; QoE: low), and urine Na+ (MD: 54.85 mmol/24 h; 95% CI: 46.31 to 63.38; QoE: moderate) compared to furosemide alone. TSA confirmed the benefit of HSS plus furosemide. Due to the heterogeneity in mortality and heart failure readmission, meta‐analysis was not performed. Our study shows that HSS plus furosemide, compared to furosemide alone, improved surrogated outcomes in ADHF patients with low or intermediate QoE. Adequately powered RCTs are still needed to assess the benefit on heart failure readmission and mortality.

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Diuretic Resistance in Heart Failure

Cited by 14 publications

References 117 publications

Ultrafiltration for patients with acute decompensated heart failure

Ultrafiltration for patients with acute decompensated heart failure

Miejsce diuretyków pętlowych w leczeniu ostrej niewydolności serca

The added value of hypertonic saline solution to furosemide monotherapy in patients with acute decompensated heart failure: A meta‐analysis and trial sequential analysis

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