Diuretic-resistant heart failure and the role of ultrafiltration : A proposed protocol
Copyright © 2023 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved..
Acute heart failure (HF) decompensation generally manifests with signs and symptoms of congestion that strongly predict poor poor patient outcome. Loop diuretics are the cornerstone of therapy to counteract fluid overload and are widely used for acute management and chronic stabilization of HF. However, a diminished response to loop diuretics is a common problem, affecting the patient's clinical course and potentially prolonging hospitalization. Diuretic resistance is defined as failure to decongest despite appropriate and escalating loop diuretic therapy. We propose a protocol for the management of diuretic resistance. The initial approach should include an assessment of causes of pseudo-diuretic resistance. Adjustments to loop diuretic therapy, such as increasing doses and frequency of administration and sequential nephron blockade, may be successful. For hospitalized patients with progressive disease there are more invasive methods for fluid removal. Switching from oral to intravenous loop diuretics is essential to avoid variable absorption and for symptomatic relief. Extracorporeal ultrafiltration is also an option since this technique is highly effective at removing plasma fluid from blood. While extracorporeal ultrafiltration is an invasive solution, peritoneal dialysis is a home-based, intermittent therapeutic option that can enable efficient management of fluid overload, preventing HF-related hospital admission, and improving quality of life. As a last resort for fluid removal, a peritoneal dialysis regimen should fully exploit its decongestive properties and should be tailored to the patient's characteristics and clinical needs.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:42 |
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| Enthalten in: |
Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology - 42(2023), 9 vom: 06. Sept., Seite 797-803 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Gomes da Silva, Francisca [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 05.09.2023 Date Revised 12.09.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.repc.2022.05.012 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
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| 520 | |a Copyright © 2023 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved. | ||
| 520 | |a Acute heart failure (HF) decompensation generally manifests with signs and symptoms of congestion that strongly predict poor poor patient outcome. Loop diuretics are the cornerstone of therapy to counteract fluid overload and are widely used for acute management and chronic stabilization of HF. However, a diminished response to loop diuretics is a common problem, affecting the patient's clinical course and potentially prolonging hospitalization. Diuretic resistance is defined as failure to decongest despite appropriate and escalating loop diuretic therapy. We propose a protocol for the management of diuretic resistance. The initial approach should include an assessment of causes of pseudo-diuretic resistance. Adjustments to loop diuretic therapy, such as increasing doses and frequency of administration and sequential nephron blockade, may be successful. For hospitalized patients with progressive disease there are more invasive methods for fluid removal. Switching from oral to intravenous loop diuretics is essential to avoid variable absorption and for symptomatic relief. Extracorporeal ultrafiltration is also an option since this technique is highly effective at removing plasma fluid from blood. While extracorporeal ultrafiltration is an invasive solution, peritoneal dialysis is a home-based, intermittent therapeutic option that can enable efficient management of fluid overload, preventing HF-related hospital admission, and improving quality of life. As a last resort for fluid removal, a peritoneal dialysis regimen should fully exploit its decongestive properties and should be tailored to the patient's characteristics and clinical needs | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Review | |
| 650 | 4 | |a Cardiorenal syndrome | |
| 650 | 4 | |a Congestão venosa | |
| 650 | 4 | |a Diuretic resistance | |
| 650 | 4 | |a Diálise peritoneal | |
| 650 | 4 | |a Heart failure | |
| 650 | 4 | |a Insuficiência cardíaca | |
| 650 | 4 | |a Peritoneal dialysis | |
| 650 | 4 | |a Resistência a diuréticos | |
| 650 | 4 | |a Síndrome cardiorrenal | |
| 650 | 4 | |a Venous congestion | |
| 650 | 7 | |a Diuretics |2 NLM | |
| 650 | 7 | |a Sodium Potassium Chloride Symporter Inhibitors |2 NLM | |
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| 700 | 1 | |a Rita Martins, Ana |e verfasserin |4 aut | |
| 700 | 1 | |a Araújo, Inês |e verfasserin |4 aut | |
| 700 | 1 | |a Aguiar, Carlos |e verfasserin |4 aut | |
| 700 | 1 | |a Fonseca, Cândida |e verfasserin |4 aut | |
| 700 | 1 | |a Branco, Patrícia |e verfasserin |4 aut | |
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