Diuretic Treatment in Heart Failure

Association between loop diuretic dose administered in first 24 hours of heart failure admissions and length of hospital stay

“…Loop diuretic efficacy may be affected by many factors, primarily bioavailability (Table 2) and loop diuretic resistance [14]. Loop diuretic resistance and adaptation are both heavily discussed in the recent literature and although there are many suggested mechanisms and risk factors, there is a gap between our understanding of the pathophysiology and fundamental clinical trials that provide guidance to therapy [7,15]. Loop diuretics are organic anions that circulate bound to proteins (> 90%), limiting their volumes of distribution.…”

“…Genetic deletion of organic anion transporters in mice leads to diuretic resistance. While gut edema and low duodenal blood flow do not typically affect oral loop diuretics bioavailability they slow absorption, thereby reducing peak plasma levels and also contributing to diuretic resistance [7]. Identified risk factors for resistance are hypotension, hyponatremia, lower kidney function, severe HF symptoms, and severe cardiac dysfunction as identified by Cleland et al [6] In order to control for loop diuretic resistance in our retrospective observational study, we divided our patient population into the three aforementioned groups based on hospital/home diuretic dose ratio in 24 h rather than absolute diuretic doses.…”

“…Patients with heart failure require higher loop diuretic dose to achieve sodium excretion [6]. Diuretic resistance has multiple studied mechanisms and it was suggested to have a different threshold for the same patient in the ADHF state [7]. The role of high-loop diuretic dose early in management of heart failure is unclear and some reports suggested its association with adverse outcomes [8].…”

İleri evre kalp yetersizliği rehberi

“…Dolayısıyla yüksek dozda intravenöz verilen loop diuretik arteriyel basıncı ve kalbin atım hacmini hem artırabilir hem de azaltabilir, hangi hastada nasıl davranacağını önceden kestirmek çoğunlukla mümkün olmaz. [240] Elimizdeki mevcut tedavi yaklaşımlarını (Tablo 14) hastanın durumuna göre yani bireysel ayarlamamız gerekmektedir.…”

“…Diuretic Optimization Strategies Evaluation (DOSE) çalışması sonuçları [196] ve diğer veriler [240,247] ışığında intravenöz tedavi şu şekilde önerilmektedir;…”