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

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SCHOOL OF MEDICINE
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Afsar, Baris
Sag, Alan A.
Kuwabara, Masanari
Covic, Adrian
Ortiz, Alberto

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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).

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Springer

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Urology and nephrology

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International Urology and Nephrology

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10.1007/s11255-020-02704-7

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