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

Journal Article (Journal Article;Review)

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).

Full Text

Duke Authors

Cited Authors

  • Acar, S; Sanli, S; Oztosun, C; Afsar, B; Sag, AA; Kuwabara, M; Covic, A; Ortiz, A; Kanbay, M

Published Date

  • September 2021

Published In

Volume / Issue

  • 53 / 9

Start / End Page

  • 1839 - 1849

PubMed ID

  • 33392884

Electronic International Standard Serial Number (EISSN)

  • 1573-2584

Digital Object Identifier (DOI)

  • 10.1007/s11255-020-02704-7


  • eng

Conference Location

  • Netherlands