A resistência aos diuréticos na insuficiência cardíaca revisitada em 2018

Translated title of the contribution: A 2018 overview of diuretic resistance in heart failure

Sofia Isabel Jardim, Luís Ramos dos Santos, Inês Araújo, Filipa Marques, Patrícia Branco, Augusta Gaspar, Cândida Fonseca

Research output: Contribution to journalReview article

1 Citation (Scopus)

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.

Original languagePortuguese
Pages (from-to)935-945
Number of pages11
JournalRevista Portuguesa de Cardiologia
Volume37
Issue number11
DOIs
Publication statusPublished - 1 Nov 2018

Fingerprint

Diuretics
Heart Failure
Sodium Potassium Chloride Symporter Inhibitors
Nephrons
Ultrafiltration
Therapeutics
Drug Interactions
Pharmaceutical Preparations
Disease Progression
Salts
Costs and Cost Analysis

Keywords

  • Diuretic resistance
  • Heart failure
  • Loop diuretic
  • Sequential nephron blockade
  • Ultrafiltration

Cite this

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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.",
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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 journalReview article

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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

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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.

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