A 2018 Overview of Diuretic Resistance in Heart Failure
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Publication Date: | 2018 |
Other Authors: | , , , , , |
Format: | Article |
Language: | eng |
Source: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Download full: | http://hdl.handle.net/10400.17/3281 |
Summary: | 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 2018 Overview of Diuretic Resistance in Heart FailureHSJ MEDDiuretics/adverse effectsDiuretics/therapeutic useDrug ResistanceHeart Failure/drug therapyHeart Failure/physiopathologyHeart 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.ElsevierRepositório do Centro Hospitalar Universitário de Lisboa Central, EPEJardim, SIRamos dos Santos, LAraújo, IMarques, FBranco, PGaspar, AFonseca, C2019-08-06T15:17:08Z20182018-01-01T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttp://hdl.handle.net/10400.17/3281engRev Port Cardiol. 2018 Nov;37(11):935-945.10.1016/j.repc.2018.03.014info:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2023-03-10T09:42:12Zoai:repositorio.chlc.min-saude.pt:10400.17/3281Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T17:20:36.249097Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
A 2018 Overview of Diuretic Resistance in Heart Failure |
title |
A 2018 Overview of Diuretic Resistance in Heart Failure |
spellingShingle |
A 2018 Overview of Diuretic Resistance in Heart Failure Jardim, SI HSJ MED Diuretics/adverse effects Diuretics/therapeutic use Drug Resistance Heart Failure/drug therapy Heart Failure/physiopathology |
title_short |
A 2018 Overview of Diuretic Resistance in Heart Failure |
title_full |
A 2018 Overview of Diuretic Resistance in Heart Failure |
title_fullStr |
A 2018 Overview of Diuretic Resistance in Heart Failure |
title_full_unstemmed |
A 2018 Overview of Diuretic Resistance in Heart Failure |
title_sort |
A 2018 Overview of Diuretic Resistance in Heart Failure |
author |
Jardim, SI |
author_facet |
Jardim, SI Ramos dos Santos, L Araújo, I Marques, F Branco, P Gaspar, A Fonseca, C |
author_role |
author |
author2 |
Ramos dos Santos, L Araújo, I Marques, F Branco, P Gaspar, A Fonseca, C |
author2_role |
author author author author author author |
dc.contributor.none.fl_str_mv |
Repositório do Centro Hospitalar Universitário de Lisboa Central, EPE |
dc.contributor.author.fl_str_mv |
Jardim, SI Ramos dos Santos, L Araújo, I Marques, F Branco, P Gaspar, A Fonseca, C |
dc.subject.por.fl_str_mv |
HSJ MED Diuretics/adverse effects Diuretics/therapeutic use Drug Resistance Heart Failure/drug therapy Heart Failure/physiopathology |
topic |
HSJ MED Diuretics/adverse effects Diuretics/therapeutic use Drug Resistance Heart Failure/drug therapy Heart Failure/physiopathology |
description |
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. |
publishDate |
2018 |
dc.date.none.fl_str_mv |
2018 2018-01-01T00:00:00Z 2019-08-06T15:17:08Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://hdl.handle.net/10400.17/3281 |
url |
http://hdl.handle.net/10400.17/3281 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
Rev Port Cardiol. 2018 Nov;37(11):935-945. 10.1016/j.repc.2018.03.014 |
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info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
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application/pdf |
dc.publisher.none.fl_str_mv |
Elsevier |
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Elsevier |
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