Determinants and impact of the natriuretic response to diuretic therapy in heart failure with reduced ejection fraction and volume overload

Verbrugge, Frederik H.; Dupont, Matthias; Bertrand, P.; Nijst, Petra; Penders, Joris; Dens, Joseph; Verhaert, David; Vandervoort, Pieter; Tang, W.H. Wilson; Mullens, Wilfried

doi:10.1080/ac.70.3.3080630

Cited by 83 publications

(82 citation statements)

References 20 publications

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“…Diuretic response should always be interpreted in light of the dose and type of the diuretic agent administered and the degree of volume overload, body composition and kidney function. As loop diuretics form the mainstay of diuretic therapy in heart failure, the terms diuretic resistance and loop diuretic resistance are often used interchangeably . To assess the response to an initiated diuretic regimen, physicians need an indicator of the diuretic response.…”

Section: Diuretic Response and Resistance In Heart Failurementioning

confidence: 99%

“…The carbonic anhydrase inhibitor acetazolamide inhibits sodium reabsorption in the proximal tubules. An observational study in patients with decompensated heart failure and marked volume overload indicated that the addition of acetazolamide (500 mg intravenous bolus on top of loop diuretic) improved loop diuretic response with ∼100 mmol Na + excreted per 40 mg of furosemide dose equivalents . Additionally, acetazolamide efficiently boosts the diuretic response in combination with loop diuretics, as illustrated by one small randomized trial including 24 patients with acute volume overload refractory to loop diuretic therapy .…”

Section: Practical Use Of Diuretics In Acute Heart Failurementioning

confidence: 99%

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The use of diuretics in heart failure with congestion — a position statement from the Heart Failure Association of the European Society of Cardiology

Mullens

Damman

Harjola

et al. 2019

European J of Heart Fail

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731

697

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The vast majority of acute heart failure episodes are characterized by increasing symptoms and signs of congestion with volume overload. The goal of therapy in those patients is the relief of congestion through achieving a state of euvolaemia, mainly through the use of diuretic therapy. The appropriate use of diuretics however remains challenging, especially when worsening renal function, diuretic resistance and electrolyte disturbances occur. This position paper focuses on the use of diuretics in heart failure with congestion. The manuscript addresses frequently encountered challenges, such as (i) evaluation of congestion and clinical euvolaemia, (ii) assessment of diuretic response/resistance in the treatment of acute heart failure, (iii) an approach towards stepped pharmacologic diuretic strategies, based upon diuretic response, and (iv) management of common electrolyte disturbances. Recommendations are made in line with available guidelines, evidence and expert opinion.

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Section: Diuretic Response and Resistance In Heart Failurementioning

confidence: 99%

Section: Practical Use Of Diuretics In Acute Heart Failurementioning

confidence: 99%

The use of diuretics in heart failure with congestion — a position statement from the Heart Failure Association of the European Society of Cardiology

Mullens

Damman

Harjola

et al. 2019

European J of Heart Fail

Self Cite

731

697

View full text Add to dashboard Cite

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“…However, the experience in daily clinical practice is limited . Verbrugge et al., in a cohort of 54 patients with acute HF and volume overload, found that a combined therapy with acetazolamide was an independent predictor of natriuresis.…”

Section: Discussionmentioning

confidence: 99%

“…Verbrugge et al., in a cohort of 54 patients with acute HF and volume overload, found that a combined therapy with acetazolamide was an independent predictor of natriuresis. Indeed, the addition of acetazolamide improved loop diuretic efficacy with approximately 100 mg of sodium excretion per 40 mg of furosemide equivalent dose . In other more recent randomized open‐label study that enrolled 20 patients with acute HF and signs of volume overload, the addition of acetazolamide over standard diuretic therapy resulted in some additional effects in parameters of diuretic efficacy and relief of dyspnea …”

Section: Discussionmentioning

confidence: 99%

Use of acetazolamide in the treatment of patients with refractory congestive heart failure

Núñez

Heredia

Payá

et al. 2018

Cardiovascular Therapeutics

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“…27,28 The close correlation with heightened cardiorenal interactions supports this as well as these markers also track with clinical response and poor outcomes. 11,29 On the other hand, this observation may also represent the tendency for patients with hepatic impairment to have a diminished natriuretic response when given loop diuretics despite their renal function. 8 Lower serum albumin levels, commonly seen in hepatic dysfunction, may represent diminished diuretic response as a result of reduced albumin-mediated loop diuretic delivery.…”

Section: Discussionmentioning

confidence: 99%

Implications of Alternative Hepatorenal Prognostic Scoring Systems in Acute Heart Failure (from DOSE-AHF and ROSE-AHF)

Grodin

Gallup

Anstrom

et al. 2017

The American Journal of Cardiology

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Because hepatic dysfunction is common in patients with heart failure, the Model for End-Stage Liver Disease (MELD) may be attractive for risk-stratification. Although alternative scores such as the MELD-XI or MELD-Na may be more appropriate in heart failure populations, the short-term clinical implications of these in patients with acute heart failure (AHF) are unknown. The MELD-XI and MELD-Na were calculated at baseline in 453 patients with AHF in the DOSE-AHF and ROSE-AHF trials. The correlations and associations for each score with cardiorenal biomarkers, short-term endpoints at 72 hours including worsening renal function and clinical events to 60 days were determined. The median MELD-XI and MELD-Na was 16 and 17, respectively. Both were correlated with baseline cystatin C, NT-proBNP, and plasma renin activity (P<0.003 for all). MELD-XI≤16 and MELD-Na≤17 were associated with a slight increase in cystatin C (P<0.02 for both), higher diuretic efficiency (P<0.001 for both), but not with change in global VAS scores (P>0.05 for both) at 72 hours. Neither score was associated with CRS or worsening heart failure (P>0.05 for all). Similarly, both the MELD-XI and MELD-Na were not associated with 60-day death/any re-hospitalization and 60-day death/heart failure re-hospitalization in adjusted analyses when analyzes as a dichotomous or continuous variable (P>0.05 for all). The alternative MELD scores correlated with baseline cardiorenal biomarkers. In conclusion, lower baseline MELD scoring was associated with higher diuretic efficiency and a slight increase in cystatin C through 72 hours. However, MELD-Na and MELD-XI were not predictive of 60-day clinical events.

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Determinants and impact of the natriuretic response to diuretic therapy in heart failure with reduced ejection fraction and volume overload

Cited by 83 publications

References 20 publications

The use of diuretics in heart failure with congestion — a position statement from the Heart Failure Association of the European Society of Cardiology

The use of diuretics in heart failure with congestion — a position statement from the Heart Failure Association of the European Society of Cardiology

Use of acetazolamide in the treatment of patients with refractory congestive heart failure

Implications of Alternative Hepatorenal Prognostic Scoring Systems in Acute Heart Failure (from DOSE-AHF and ROSE-AHF)

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