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*

*Bijbehorende auteur voor dit werk

Onderzoeksoutputpeer review

197 Citaten (Scopus)


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.

Originele taal-2English
Pagina's (van-tot)184-192
Aantal pagina's9
TijdschriftNature reviews cardiology
Nummer van het tijdschrift3
StatusPublished - mrt.-2015


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