Pharmacologic and interventional paradigms of diuretic resistance in congestive heart failure: a narrative review

Acar, Simge; Sanli, Sueda; Oztosun, Cinar; Afsar, Barış; Sag, Alan A.; Kuwabara, Masanari; Covic, Adrian; Ortíz, Alberto; Kanbay, Mehmet

doi:10.1007/s11255-020-02704-7

Cited by 6 publications

(10 citation statements)

References 64 publications

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“…ADHF accounts for more than 1 million hospitalizations per year in the United States, and inadequate diuresis is a common cause of readmissions and higher mortality. 1 In the absence of cardiogenic shock, ADHF manifestations are driven primarily by expansion of extracellular fluid volume, leading to elevated cardiac filling pressures and congestion (edema, dyspnea, and orthopnea). 2,3 Despite the evidence supporting guideline-directed medical therapy, studies guiding diuresis are limited.…”

Section: Qmentioning

confidence: 99%

“…2 Furosemide, torsemide, and bumetanide are the most used (Table 1). 1,4,5 Torsemide and bumetanide have better bioavailability than furosemide, and data suggest torsemide superiority, given its possible improved outcomes and mitigation of cardiac fibrosis. 3…”

Section: ■ Loop Diureticsmentioning

confidence: 99%

“…2 Recent data suggest that using urine output and spot urine sodium to predict short-term responsiveness to intravenous loop diuretics in ADHF permits more timely adjustments to therapy (Figure 2). [1][2][3] With this approach, if the goal of a urine output of more than 150 mL/hour or a urine sodium greater than 50 to 70 mEq/L is not achieved at 2 hours after the initial dose, the dose should be doubled and the parameters rechecked 2 hours after the repeat dose until the goals are met. When the goals are met, the same dose can be administered every 6 to 12 hours until volume overload resolves.…”

Section: Initial Dosingmentioning

confidence: 99%

See 2 more Smart Citations

How do we maximize diuresis in acute decompensated heart failure?

Mirzai

Kanaan²,

Berglund³

et al. 2022

CCJM

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Section: Qmentioning

confidence: 99%

Section: ■ Loop Diureticsmentioning

confidence: 99%

Section: Initial Dosingmentioning

confidence: 99%

See 1 more Smart Citation

How do we maximize diuresis in acute decompensated heart failure?

Mirzai

Kanaan²,

Berglund³

et al. 2022

CCJM

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“…Рассматривая перспективные подходы, направленные на преодоление РД, которые обсуждаются в настоящее время, можно отметить введение гипертонического солевого раствора в сочетании с высокой дозой петлевого диуретика [113,114], подкожный способ инфузии фуросемида [115,116], совершенствование секвенциальной блокады нефрона за счет хронотерапевтического подхода (например, назначение препарата тиазидного ряда за 30 мин до петлевого диуретика) [43,117], применение не нейтрализующих моноклональных антител к адреномедуллину, увеличивающих период его полувыведения и способствующих перемещению этого вазоактивного пептида из интерстиция в кровоток (адрецизумаб) [117,118], воздействие на апелинергическую систему [119,120], а также блокаду симпатических грудных ганглиев (на уровне от T6 до Т11) лидокаином [121,122].…”

Section: профилактика и преодоление резистентности к диуретикамunclassified

Diuretic resistance in patients with chronic heart failure: mechanisms, prevention, and treatment

et al. 2022

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The authors analyzed the problem of diuretic resistance (DR) in patients with chronic heart failure (CHF). Most of the symptoms and signs of CHF are associated with hypervolemia and vascular congestion in the systemic and pulmonary circulation. The severity of the latter is the main factor which negatively affects the overall assessment of life satisfaction in patients with CHF. Since the patient, even at the incurable stage of CHF, primarily expects a rapid decrease in the severity of manifestations of decompensation from the prescribed therapy, achieving euvolemia is the essence of its short-term objective. Without diuretics, these immediate effects, according to which most CHF patients judge the qualifications of the doctor, are almost impossible to achieve. Unfortunately, apparently, not a single clinician was able to avoid disappointment in the effectiveness of CHF therapy associated with DR in their practice. As a rule, DR reflects the progressive course of CHF and is often associated with a poor prognosis. The review consistently covers the issues of terminology, diagnosis, pathogenesis, and prevention of DR, which aggravates CHF, and discusses measures aimed at restoring sensitivity to diuretics.

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“…This helps overcome the plateau achieved in water and sodium excretion with loop diuretics only. 30 , 31 In another retrospective cohort of acute decompensated heart failure patients, hypertonic saline solution (HSS) was associated with increased diuretic efficacy, fluid loss, and metabolic improvement. 32 In contrast, the study highlighted here is essentially a negative trial that failed to demonstrate claimed benefits of HSS.…”

mentioning

confidence: 99%