Diuretic response in acute heart failure -pathophysiology, evaluation, and therapy

Jozine M. ter Maaten, Mattia A. E. Valente, Kevin Damman, Hans L. Hillege, Gerjan Navis, Adriaan A. Voors*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

148 Citations (Scopus)

Abstract

The administration of loop diuretics to achieve decongestion is the cornerstone of therapy for acute heart failure. Unfortunately, impaired response to diuretics is common in these patients and associated with adverse outcomes. Diuretic resistance is thought to result from a complex interplay between cardiac and renal dysfunction, and specific renal adaptation and escape mechanisms, such as neurohormonal activation and the braking phenomenon. However, our understanding of diuretic response in patients with acute heart failure is still limited and a uniform definition is lacking. Three objective methods to evaluate diuretic response have been introduced, which all suggest that diuretic response should be determined based on the effect of diuretic dose administered. Several strategies have been proposed to overcome diuretic resistance, including combination therapy and ultrafiltration, but prospective studies in patients who are truly unresponsive to diuretics are lacking. An enhanced understanding of diuretic response should ultimately lead to an improved, individualized approach to treating patients with acute heart failure.

Original languageEnglish
Pages (from-to)184-192
Number of pages9
JournalNature reviews cardiology
Volume12
Issue number3
DOIs
Publication statusPublished - Mar-2015

Keywords

  • HYPERTONIC SALINE SOLUTION
  • HIGH-DOSE FUROSEMIDE
  • CONVERTING ENZYME-INHIBITOR
  • NATRIURETIC EFFECT ADDITION
  • PERMUTATION TRIAL TESTS
  • CHRONIC KIDNEY-DISEASE
  • BLOOD UREA NITROGEN
  • LONG-TERM TREATMENT
  • RENAL-FUNCTION
  • NEUROHORMONAL ACTIVATION

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