Loop diuretics in acute heart failure: beyond the decongestive relief for the kidney

Critical Care : the Official Journal of the Critical Care Forum
Alberto PalazzuoliPeter A McCullough

Abstract

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 acut...Continue Reading

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Citations

Jun 10, 2016·International Journal of Clinical Practice·O J ZiffD Goldsmith
Jan 24, 2018·Heart Failure Reviews·Alberto PalazzuoliRanuccio Nuti
Oct 28, 2017·Future Medicinal Chemistry·Birgit T Priest, Alexander Pasternak
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Oct 17, 2019·ESC Heart Failure·Alberto PalazzuoliPasquale Perrone Filardi
Sep 7, 2018·AACN Advanced Critical Care·Mark Priddy, Czarina Bock
Dec 20, 2019·Therapeutic Advances in Cardiovascular Disease·Takahiro KambaraMasayoshi Ajioka
Nov 9, 2019·Heart Failure Reviews·Gaetano RuoccoJozine M Ter Maaten
Jul 25, 2017·American Journal of Physiology. Heart and Circulatory Physiology·Hiroyuki Takahama, Masafumi Kitakaze
Mar 16, 2019·Pharmacology Research & Perspectives·Toshihiro SawabeAkiyuki Takaya
May 8, 2020·Heart Failure Reviews·Alberto Palazzuoli, Isabella Evengelista

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