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Review
. 2021 Sep;53(9):1839-1849.
doi: 10.1007/s11255-020-02704-7. Epub 2021 Jan 3.

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

Simge Acar  1 , Sueda Sanli  1 , Cinar Oztosun  1 , Baris Afsar  2 , Alan A Sag  3 , Masanari Kuwabara  4   5 , Adrian Covic  6 , Alberto Ortiz  7 , Mehmet Kanbay  8
Affiliations
Review

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

Simge Acar et al. Int Urol Nephrol. 2021 Sep.

Abstract

Diuretic volume reduction continues to be the mainstay of congestive heart failure (CHF) management globally. However, diuretic resistance is a critical topic that lacks standardized evidence-based management guidelines accounting for mechanisms of diuretic resistance, renal function, and co-morbidities. Major healthcare utilization consequences result from this. The authors herein reconcile the definition of renal functional decline with emphasis on biomarker-driven assessment. Novel goal-directed treatment approaches are reviewed including hypertonic saline, acetazolamide, sodium-glucose transporter inhibition, sequential nephron blockade and Elabela-APJ axis targeting are reviewed, as well as percutaneous visceral splanchnic sympathectomy (converting a volume-focused to a distribution-focused paradigm).

Keywords: Acute kidney injury; Diuretic; Heart failure; Hypertonic saline; Hypervolemia.

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References

    1. Givertz MM, Teerlink JR, Albert NM, Westlake Canary CA, Collins SP, Colvin-Adams M et al (2013) Acute decompensated heart failure: update on new and emerging evidence and directions for future research. J Card Fail 19(6):371–389 - PubMed - DOI - PMC
    1. Griffin M, Soufer A, Goljo E, Colna M, Rao VS, Jeon S et al (2020) Real world use of hypertonic saline in refractory acute decompensated heart failure: A U.S. Center’s experience. JACC Heart Fail 8(3):199–208 - PubMed - PMC - DOI
    1. ter Maaten JM, Valente MA, Damman K, Hillege HL, Navis G, Voors AA (2015) Diuretic response in acute heart failure-pathophysiology, evaluation, and therapy. Nat Rev Cardiol 12(3):184–192 - PubMed - DOI - PMC
    1. Hasselblad V, GattisStough W, Shah MR, Lokhnygina Y, O’Connor CM, Califf RM et al (2007) Relation between dose of loop diuretics and outcomes in a heart failure population: results of the ESCAPE trial. Eur J Heart Fail 9(10):1064–1069 - PubMed - DOI - PMC
    1. Nistor I, Bararu I, Apavaloaie MC, Voroneanu L, Donciu MD, Kanbay M et al (2015) Vasopressin receptor antagonists for the treatment of heart failure: a systematic review and meta-analysis of randomized controlled trials. Int UrolNephrol 47(2):335–344

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