Diuretic resistance – how to overcome? Review article
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Abstract
Diuretic therapy remains a cornerstone of therapy for patients with chronic heart failure and clearly improve symptoms and quality of life. Resistance to diuretic action is frequently encountered in the clinical setting. Diuretic resistance may be caused by decreased renal function and reduced and delayed peak concentrations of loop diuretics in the tubular fluid but chronic treatment with a diuretic results in compensatory hypertrophy of epithelial cells and consequently its diuretic effect will be blunted. Strategies to overcome diuretic resistance include restriction of sodium intake. Salt intake must be restricted in patients with heart failure to obtain a negative sodium balance. Pharmacodynamic measures include improving the underlying disease state, limiting the use of vasodilators and eliminating drugs which may modify the response to the diuretic. Concomitant administration of a more distally acting diuretic will usually result in substantial diuresis. Diuretic resistance can also be managed by increasing the frequency of loop diuretic dosing or by switching to a continuous intravenous infusion. Potassium sparing diuretics may also be able to increase the effectiveness of more proximally acting diuretics. Ultrafiltration has also been used as a nonpharmacologic strategy to treat patients who exhibit resistance to diuretics. Effective monitoring of volume status with newer modalities may allow more selective use of diuretics.
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Copyright: © Medical Education sp. z o.o. This is an Open Access article distributed under the terms of the Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). License (https://creativecommons.org/licenses/by-nc/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
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