Abstract
Diuretic therapy decreases capillary wedge pressure and improves New York Heart Association
(NYHA) functional class both in acute and chronic heart failure. In advanced symptomatic
heart failure, loop diuretics are generally necessary to improve symptoms of congestion.
Diuretic resistance in the edematous patient has been defined as a clinical state
in which diuretic response is diminished or lost before the therapeutic goal of relief
from edema has been reached. The major causes of diuretic resistance are functional
renal failure (prerenal azotemia), hyponatremia, altered diuretic pharmacokinetics,
and sodium retention caused by counterregulatory mechanisms intended to reestablish
the effective arterial blood volume. Therapeutic approaches to combat diuretic resistance
include restriction of fluid and sodium intake, use of angiotensin-converting-enzyme
(ACE) inhibitors, changes in route (oral, intravenous) and timing (single dose, multiple
doses, continuous infusion) of diuretic therapy, and use of diuretic combinations.
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Article info
Publication history
Published online: August 16, 2004
Accepted:
August 26,
1998
Received in revised form:
August 26,
1998
Received:
May 4,
1998
Identification
Copyright
© 1999 Excerpta Medica Inc. Published by Elsevier Inc. All rights reserved.
