The pathophysiology and management of diuretic resistance in patients with heart failure

ABSTRACT

Objectives

The objectives of the study are to investigate the causes of diuretic resistance in patients with advanced congestive heart failure (CHF), since diuretics are the cornerstone of treatment of these patients. Several studies have shown that diuretic resistance in patients with advanced CHF is common, ranging from 25% to 50% in hospitalized patients.

Methods

In order to get a current perspective as to the magnitude of diuretic resistance in such patients, a focused Medline search of the English language literature was conducted between 2015 and 2020 using the search terms, CHF, diuretics, treatment, resistance, frequency, and 30 papers with pertinent information were selected.

Results

The analysis of data from the selected papers demonstrated that diuretic resistance is common in hospitalized patients with advanced CHF and frequently associated with renal failure, which is secondary to CHF.

Conclusions

Diuretic resistance appears to be common in patients with advanced CHF and it is mostly due to decreased cardiac output, low blood pressure, decreased glomerular filtration rate, decreased filtration of sodium, and increased tubular reabsorption of sodium. Diuretic resistance in such patients can be overcome with the combination of loop diuretics with thiazide and thiazide-like diuretics, aldosterone antagonists, as well as other agents. The data from these studies in combination with collateral literature will be discussed in this review.

KEYWORDS:

• Congestive heart failure
• treatment
• diuretics
• resistance
• renal failure
• diuretic combinations

Acknowledgments

The authors wish to express their gratitude to Lisa Marie Zarrella, chief librarian of medical library, Baptist Medical Center, Oklahoma City, OK

Declaration of financial/other relationships

The contents of the paper and the opinions expressed within are those of the authors, and it was the decision of the authors to submit the manuscript for publication.

The author declares no conflict of interest and that no funds were received for the preparation of the manuscript.

Declaration of interest

No potential conflict of interest was reported by the authors.

Declaration of funding

No funding was received to produce this article.