Loop diuretics in acute heart failure: beyond the decongestive relief for the kidney.
Current goals in the acute treatment of heart failure are focused on pulmonary and systemic decongestion with loop diuretics as the cornerstone of therapy. Despite rapid relief of symptoms in patients with acute decompensated heart failure, after intravenous use of loop diuretics, the use of these agents has been consistently associated with adverse events, including hypokalemia, azotemia, hypotension, and increased mortality. Two recent randomized trials have shown that continuous infusions of loop diuretics did not offer benefit but were associated with adverse events, including hyponatremia, prolonged hospital stay, and increased rate of readmissions. This is probably due to the limitations of congestion evaluation as well as to the deleterious effects linked to drug administration, particularly at higher dosage. The impaired renal function often associated with this treatment is not extensively explored and could deserve more specific studies. Several questions remain to be answered about the best diuretic modality administration, global clinical impact during acute and post-discharge period, and the role of renal function deterioration during treatment. Thus, if loop diuretics are a necessary part of the treatment for acute heart failure, then there must be an approach that allows personalization of therapy for optimal benefit and avoidance of adverse events.
Department of Internal and Surgical Medicine, Cardiovascular Diseases Unit, Le Scotte Hospital, University of Siena Viale Bracci, 53100, Siena, Italy. palazzuoli2@unisi.it.
Alberto
A
Palazzuoli
Department of Internal and Surgical Medicine, Cardiovascular Diseases Unit, Le Scotte Hospital, University of Siena Viale Bracci, 53100, Siena, Italy.
Gaetano
G
Ruocco
Nephrology Dialysis & Transplantation International Renal Research Institute (IRRIV) St. Bortolo Hospital, Viale Rodolfi 37, IT-36100, Vicenza, Italy.
Claudio
C
Ronco
Baylor University Medical Center, Baylor Heart and Vascular Institute, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, 621 North Hall Street, H030, Dallas, Texas, 75226, USA.
Peter A
PA
McCullough
D000208:Acute Disease; D000465:Algorithms; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D057285:Precision Medicine / Q000379:methods; D051437:Renal Insufficiency / Q000139:chemically induced; D049994:Sodium Potassium Chloride Symporter Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
D049994:Sodium Potassium Chloride Symporter Inhibitors