title: [Alternatives to conventional diuretic therapy in heart failure].
abstract: Although treatment of acute heart failure is based primarily on the administration of intravenous loop diuretics, evidence supporting this practice is still scarce and there is uncertainty about the optimal dose. The existence of a considerable percentage of patients refractory to diuretic therapy and worsening of renal failure associated with the use of these drugs, with possible implications for medium-term mortality, have prompted the search for more effective and safer alternatives. Extracorporeal purification techniques, such as ultrafiltration, have demonstrated efficacy, although their superiority is unclear, due to the possible adverse effects associated with the procedure. The use of low-dose dopamine is not superior to conventional diuretic therapy after the first few hours of treatment. Moreover, combination with furosemide and hypertonic saline could be a valid alternative for patients with refractory congestion and depressed ejection fraction and serum creatinine ≤ 2.5mg/dL, but further studies are needed before its widespread use. The use of tolvaptan may be an effective alternative in the short-term but its use may be limited by its price. There is still controversy about whether treatment with loop diuretics is associated with higher mortality in all groups of patients with HF exacerbations. These controversies should be clarified by future clinical trials.
authors.affiliation: Servicio de Medicina, Hospital Universitari Arnau de Vilanova, Lleida, España. Electronic address: jl.morales@ono.com.
authors.forename: José Luis
authors.initials: JL
authors.lastname: Morales-Rull
authors.affiliation: Servicio de Medicina Interna, Hospital Sant Jaume de Olot, Olot, Girona, Universitat de Girona, Girona, España.
authors.forename: Joan Carles
authors.initials: JC
authors.lastname: Trullàs
authors.affiliation: Servicio de Medicina Interna, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España.
authors.forename: Francesc
authors.initials: F
authors.lastname: Formiga
mesh_terms: D000208:Acute Disease; D065092:Antidiuretic Hormone Receptor Antagonists / Q000008:administration & dosage / Q000627:therapeutic use; D001552:Benzazepines / Q000008:administration & dosage / Q000627:therapeutic use; D059347:Cardio-Renal Syndrome / Q000209:etiology / Q000517:prevention & control; D002986:Clinical Trials as Topic; D004298:Dopamine / Q000627:therapeutic use; D004351:Drug Resistance; D057915:Drug Substitution; D004359:Drug Therapy, Combination; D005665:Furosemide / Q000008:administration & dosage / Q000627:therapeutic use; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D006440:Hemofiltration; D006801:Humans; D015337:Multicenter Studies as Topic; D012462:Saline Solution, Hypertonic / Q000008:administration & dosage / Q000627:therapeutic use; D049994:Sodium Potassium Chloride Symporter Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D013318:Stroke Volume; D000077602:Tolvaptan
chemical_list: D065092:Antidiuretic Hormone Receptor Antagonists; D001552:Benzazepines; D012462:Saline Solution, Hypertonic; D049994:Sodium Potassium Chloride Symporter Inhibitors; D000077602:Tolvaptan; D005665:Furosemide; D004298:Dopamine
keywords: Diuretics; Diuréticos; Dopamina; Dopamine; Furosemida; Furosemide; Heart failure; Hipertónico; Hypertonic; Insuficiencia cardíaca; Tolvaptan; Tolvaptán; Ultrafiltración; Ultrafiltration