Novel Diuretic Strategies for the Treatment of Heart Failure in Japan

Clinical Scenario 1 Is Associated With Winter Onset of Acute Heart Failure

“…25 Sustained natriuretic action of long-acting loop diuretics may contribute to minimizing neurohumoral activation and rebound sodium retention. 26 The subjects of this study were admitted from 2004 through 2010 before the report of Masuyama et al Thus the prescription rate of long-acting loop diuretics was quite low in the present study. Further studies are required to investigate the preventive effect of long-acting loop diuretics for winter onset of AHF.…”

Diuretic effects of sodium–glucose cotransporter 2 inhibitor in patients with type 2 diabetes mellitus and heart failure

“…Loop diuretics are prescribed to the vast majority of patients with symptomatic HF, but they directly upregulate renin gene expression by blocking sodium chloride uptake at the macula densa, which activates the renin-angiotensin-aldosterone system (RAAS) and the sympathetic nervous system (SNS), both of which are known to have adverse effects in heart failure [4][5][6]. Recently, a new class of oral glucose-lowering agents that inhibit renal sodium-glucose cotransporter 2 (SGLT2) has been approved.…”

“…These results indicate that ipragliflozin has great potential as a novel and effective diuretic agent. Ipragliflozin treatment also increased potassium excretion without influencing serum potassium concentration, probably due to the increased delivery of sodium to the distal nephron, which activates sodium reabsorption and potassium secretion in the distal convoluted tubule and in the connecting tubule [9].To prevent rehospitalization, patients with HF generally require chronic oral loop diuretic treatment [10], but it can worsen renal function and activate the RAAS and SNS, all of which play fundamental roles in HF progression [4][5][6]. In the present study, short-term ipragliflozin therapy in patients on chronic oral diuretics decreased plasma natriuretic peptide levels without influencing plasma angiotensin II, aldosterone and noradrenaline levels.…”

Quantitative Assessment of Fluid Accumulation Using Bioelectrical Impedance Analysis in Patients With Acute Decompensated Heart Failure

“…The treatment of ADHF usually involves systemic and pulmonary decongestion while avoiding intravascular underfilling and detrimental neurohumoral upregulation. 7 For this reason, accurate quantification of the degree of fluid accumulation in each ADHF patient is of critical importance in assessing whether adequate decongestion has been achieved. Although there are several methods currently available for assessing fluid accumulation in ADHF patients, these allow only qualitative evaluation and are therefore inadequate for supporting effective ADHF management.…”