title: Intra-abdominal Hypertension: An Important Consideration for Diuretic Resistance in Acute Decompensated Heart Failure.
abstract: Fluid accumulation is the hallmark of heart failure decompensation. Fluid overload and congestion are associated with recurrent hospitalizations, poor quality of life, and increased mortality in heart failure. Despite the use of high-dose intravenous loop diuretic therapy, acutely decompensated heart failure patients may develop diuretic resistance. Diuretic refractoriness can be a result of elevated intra-abdominal pressure (IAP) in acutely decompensated heart failure. Increased renal venous and interstitial pressures in patients with elevated IAP may lead to renal impairment and diuretic resistance. Routine approaches such as sequential nephron blockade with a combination of loop and thiazide or thiazide-like diuretics, continuous diuretic infusion, and ultrafiltration may not be sufficient. Presented here is a case illustrating the importance of recognizing intra-abdominal hypertension in patients with diuretic resistance. Lowering IAP improves renal perfusion, renal filtration, and diuresis. When elevated, IAP is an easily reversible cause of diuretic resistance. Additionally, abdominal perfusion pressure can be used to guide therapy to reverse end-organ damage and avoid permanent renal replacement therapy.
authors.affiliation: Tulane University Heart and Vascular Institute, Tulane School of Medicine, New Orleans, Louisiana.
authors.forename: Vinh Q
authors.initials: VQ
authors.lastname: Nguyen
authors.affiliation: Tulane University Heart and Vascular Institute, Tulane School of Medicine, New Orleans, Louisiana.
authors.forename: Taraka V
authors.initials: TV
authors.lastname: Gadiraju
authors.affiliation: Tulane University Heart and Vascular Institute, Tulane School of Medicine, New Orleans, Louisiana.
authors.forename: Hiren
authors.initials: H
authors.lastname: Patel
authors.affiliation: Tulane University Heart and Vascular Institute, Tulane School of Medicine, New Orleans, Louisiana.
authors.forename: Minnsun
authors.initials: M
authors.lastname: Park
authors.affiliation: Tulane University Heart and Vascular Institute, Tulane School of Medicine, New Orleans, Louisiana.
authors.forename: Thierry H
authors.initials: TH
authors.lastname: Le Jemtel
authors.affiliation: Tulane University Heart and Vascular Institute, Tulane School of Medicine, New Orleans, Louisiana.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Jaiswal
mesh_terms: D000368:Aged; D004231:Diuresis; D004232:Diuretics / Q000627:therapeutic use*; D004351:Drug Resistance; D017809:Fatal Outcome; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D059325:Intra-Abdominal Hypertension / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D008297:Male; D019152:Paracentesis; D011237:Predictive Value of Tests; D012307:Risk Factors; D016896:Treatment Outcome; D014546:Urinary Catheterization
chemical_list: D004232:Diuretics