Prevalence and outcome of diuretic resistance in heart failure

Trullàs, Joan Carles; Casado, Jesús; Morales-Rull, J.L.; Formiga, Francesç; Conde-Martel, Alicia; Quirós, Raúl Guzmán; Epelde, Francisco; González-Franco, Álvaro; Manzano, Luís; Montero-Pérez-Barquero, Manuel

doi:10.1007/s11739-018-02019-7

Cited by 35 publications

(23 citation statements)

References 24 publications

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“…This study shows a high prevalence of chronic DR after HF admission in a real-world population. As was noted in other studies, patients with chronic DR have greater HF readmissions and mortality [3]. On the bases of our results we can predict chronic DR during a HF hospitalization, which is highly useful for deciding the better management after discharge.…”

Section: Plos Onesupporting

confidence: 78%

“…However, diuretic resistance (DR) is a common condition during a HF hospitalization, and is related to increase readmission and mortality [1]. Generally speaking, there is DR when symptoms and signs of congestion persist even with increasing diuretic dose, but in chronic HF the definition of persistent congestion even with furosemide daily dose of � 80mg has been commonly used [2,3]. Although the risk factors for DR during a HF hospitalization are widely described, we do not know whether the risk of chronic DR could be predicted during admission.…”

Section: Introductionmentioning

confidence: 99%

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The development of chronic diuretic resistance can be predicted during a heart-failure hospitalization. Results from the REDIHF registry

et al. 2020

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The authors have declared that no competing interests exist. (21.2%) had chronic DR. The dose of furosemide before admission and the decrease in NT-proBNP �30% during admission were predictors of chronic DR in the multivariate analysis. Conclusions We can predict during a HF hospitalization which patients will develop chronic DR. The dose of furosemide before admission and the change in NT-proBNP are independent predictors of chronic DR.

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Section: Plos Onesupporting

confidence: 78%

Section: Introductionmentioning

confidence: 99%

The development of chronic diuretic resistance can be predicted during a heart-failure hospitalization. Results from the REDIHF registry

et al. 2020

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“…Second, diuretic resistance, a phenomenon often seen in CHF, may hamper the success of decongestive therapy. Diuretic resistance is most commonly defined as the inability to achieve an adequate natriuretic and diuretic response despite high doses of diuretics; 27,40 however, no universal definition exists. Diuretic response is a measure of decongestive effect in relation to diuretic dose, often defined as weight change per 40 mg furosemide.…”

Section: Diuretic Resistancementioning

confidence: 99%

“…and sodium, higher uric acid at admission and the patients with diuretic resistance had 37% higher risk of dying within a year. 40…”

Section: Myocardial Functionmentioning

confidence: 99%

Congestion and Diuretic Resistance in Acute or Worsening Heart Failure

2020

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Hospitalisation for acute heart failure (AHF) is associated with high mortality and high rehospitalisation rates. In the absence of evidence-based therapy, treatment is aimed at stabilisation and symptom relief. The majority of AHF patients have signs and symptoms of fluid overload, and, therefore, decongestion is the number one treatment goal. Diuretics are the cornerstone of therapy in AHF, but the treatment effect is challenged by diuretic resistance and poor diuretic response throughout the spectrum of chronic to worsening to acute to post-worsening HF. Adequate dosing and monitoring and evaluation of diuretic effect are important for treatment success. Residual congestion at discharge is a strong predictor of worse outcomes. Therefore, achieving euvolaemia is crucial despite transient worsening renal function.

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“…In our experience, more than half of the patients admitted for decompensated HF are already receiving chronic loop diuretic treatment and up to 21% in doses ≥ 80 mg/day of oral furosemide . It is very likely that many of these patients have ‘true’ diuretic resistance because prolonged exposure to loop diuretics causes renal adaptation, with progressive hypertrophy and hyperfunction of the distal nephron, increasing local sodium reabsorption.…”

mentioning

confidence: 99%