Abstract
Heart failure is a disease with high direct and indirect costs. Current treatment includes drugs that alter disease progression and drugs that to improve symptoms. Loop diuretics are the cornerstone of congestion relief for acute management, as well as for chronic stabilization. In heart failure patients, maximal diuretic response is reduced by many individual factors. Diuretic resistance is defined as failure to achieve effective congestion relief despite appropriate or escalating diuretic doses. Its causes include impaired delivery of the diuretic to its luminal site of action, neurohormonal activation, tubular compensatory adaptation and drug interactions. Several strategies can be employed to aid decongestion of patients with impaired diuretic response. These include salt restriction, a higher effective single dose or higher dose frequency of loop diuretics, continuous infusion of diuretics and/or sequential nephron blockade through a synergistic combination of two or more diuretics from different classes. Ultrafiltration has also been found to be another effective and safe therapeutic option and should be considered in patients with refractory diuretic resistance. Overall, there is a lack of high-quality clinical data to guide the choice of treatment strategy and therapy should be tailored on a case-by-case basis.
| Translated title of the contribution | A 2018 overview of diuretic resistance in heart failure |
|---|---|
| Original language | Portuguese |
| Pages (from-to) | 935-945 |
| Number of pages | 11 |
| Journal | Revista Portuguesa de Cardiologia |
| Volume | 37 |
| Issue number | 11 |
| DOIs | |
| Publication status | Published - 1 Nov 2018 |
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Keywords
- Diuretic resistance
- Heart failure
- Loop diuretic
- Sequential nephron blockade
- Ultrafiltration
Cite this
}
A resistência aos diuréticos na insuficiência cardíaca revisitada em 2018. / Jardim, Sofia Isabel; Ramos dos Santos, Luís; Araújo, Inês; Marques, Filipa; Branco, Patrícia; Gaspar, Augusta; Fonseca, Cândida.
In: Revista Portuguesa de Cardiologia, Vol. 37, No. 11, 01.11.2018, p. 935-945.Research output: Contribution to journal › Review article
TY - JOUR
T1 - A resistência aos diuréticos na insuficiência cardíaca revisitada em 2018
AU - Jardim, Sofia Isabel
AU - Ramos dos Santos, Luís
AU - Araújo, Inês
AU - Marques, Filipa
AU - Branco, Patrícia
AU - Gaspar, Augusta
AU - Fonseca, Cândida
PY - 2018/11/1
Y1 - 2018/11/1
N2 - Heart failure is a disease with high direct and indirect costs. Current treatment includes drugs that alter disease progression and drugs that to improve symptoms. Loop diuretics are the cornerstone of congestion relief for acute management, as well as for chronic stabilization. In heart failure patients, maximal diuretic response is reduced by many individual factors. Diuretic resistance is defined as failure to achieve effective congestion relief despite appropriate or escalating diuretic doses. Its causes include impaired delivery of the diuretic to its luminal site of action, neurohormonal activation, tubular compensatory adaptation and drug interactions. Several strategies can be employed to aid decongestion of patients with impaired diuretic response. These include salt restriction, a higher effective single dose or higher dose frequency of loop diuretics, continuous infusion of diuretics and/or sequential nephron blockade through a synergistic combination of two or more diuretics from different classes. Ultrafiltration has also been found to be another effective and safe therapeutic option and should be considered in patients with refractory diuretic resistance. Overall, there is a lack of high-quality clinical data to guide the choice of treatment strategy and therapy should be tailored on a case-by-case basis.
AB - Heart failure is a disease with high direct and indirect costs. Current treatment includes drugs that alter disease progression and drugs that to improve symptoms. Loop diuretics are the cornerstone of congestion relief for acute management, as well as for chronic stabilization. In heart failure patients, maximal diuretic response is reduced by many individual factors. Diuretic resistance is defined as failure to achieve effective congestion relief despite appropriate or escalating diuretic doses. Its causes include impaired delivery of the diuretic to its luminal site of action, neurohormonal activation, tubular compensatory adaptation and drug interactions. Several strategies can be employed to aid decongestion of patients with impaired diuretic response. These include salt restriction, a higher effective single dose or higher dose frequency of loop diuretics, continuous infusion of diuretics and/or sequential nephron blockade through a synergistic combination of two or more diuretics from different classes. Ultrafiltration has also been found to be another effective and safe therapeutic option and should be considered in patients with refractory diuretic resistance. Overall, there is a lack of high-quality clinical data to guide the choice of treatment strategy and therapy should be tailored on a case-by-case basis.
KW - Diuretic resistance
KW - Heart failure
KW - Loop diuretic
KW - Sequential nephron blockade
KW - Ultrafiltration
UR - http://www.scopus.com/inward/record.url?scp=85056712299&partnerID=8YFLogxK
U2 - 10.1016/j.repc.2018.03.014
DO - 10.1016/j.repc.2018.03.014
M3 - Review article
VL - 37
SP - 935
EP - 945
JO - Revista Portuguesa de Cardiologia
JF - Revista Portuguesa de Cardiologia
SN - 0870-2551
IS - 11
ER -