title: Loop diuretic therapy in heart failure: the need for solid evidence on a fluid issue.
abstract: BACKGROUND
  Heart failure (HF) is a common condition associated with substantial cost, morbidity, and mortality. Because results of clinical trials in the acute decompensated heart failure (ADHF) setting have been mostly neutral, loop diuretics remain the mainstay of treatment.
  
  
  OBJECTIVE
  Loop diuretic use may be associated with unfavorable outcomes.
  
  
  METHODS
  A MEDLINE literature search was performed to identify articles relating to heart failure and loop diuretics. The current evidence on the risks and benefits of loop diuretics for the treatment of ADHF is reviewed.
  
  
  RESULTS
  Loop diuretics are associated with symptomatic improvements in congestion, urine output, and body weight, but have shown no long-term mortality benefit. Loop diuretics, especially at high doses, are associated with worsened renal function and other poor outcomes.
  
  
  CONCLUSIONS
  Loop diuretics still prove useful in HF treatment, but risk-benefit analysis of these agents in the treatment of ADHF requires a well-designed prospective study.
authors.affiliation: Department of Medicine, Cardiology Division, Loma Linda University School of Medicine, Loma Linda, California 92354, USA. jchiong@llu.edu
authors.forename: Jun R
authors.initials: JR
authors.lastname: Chiong
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Cheung
mesh_terms: D004351:Drug Resistance; D019317:Evidence-Based Medicine; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D007263:Infusions, Parenteral; D007267:Injections; D007668:Kidney / Q000187:drug effects* / Q000503:physiopathology; D018579:Patient Selection; D018570:Risk Assessment; D012307:Risk Factors; D049994:Sodium Potassium Chloride Symporter Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D016896:Treatment Outcome; D014882:Water-Electrolyte Balance / Q000187:drug effects*
chemical_list: D049994:Sodium Potassium Chloride Symporter Inhibitors