scholarly journals Mechanism and management of diuretic resistance in congestive heart failure

2012 ◽  
Vol 17 (1) ◽  
pp. 44-46
Author(s):  
Dipankar Chandra Nag ◽  
AKM Murshed ◽  
Rajashis Chakrabortty ◽  
Md Raziur Rahman
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Sodium Intake ◽  
Diuretic Therapy ◽  
Compensatory Hypertrophy ◽  
Loop Diuretics ◽  
Thick Ascending Limb ◽  
Diuretic Resistance ◽  
First Line Therapy ◽  
Advanced Stages

Diuretic drugs are used almost universally in patients with congestive heart failure, most frequently the potent loop diuretics. Despite their unproven effect on survival, their indisputable efficacy in relieving congestive symptoms makes them first line therapy for most patients. In the treatment of more advanced stages of heart failure diuretics may fail to control salt and water retention despite the use of appropriate doses. Diuretic resistance may be caused by decreased renal function and reduced and delayed peak concentrations of loop diuretics in the tubular fluid, but it can also be observed in the absence of these pharmacokinetic abnormalities. When the effect of a short acting diuretic has worn off, postdiuretic salt retention will occur during the rest of the day. Chronic treatment with a loop diuretic results in compensatory hypertrophy of epithelial cells downstream from the thick ascending limb and consequently its diuretic effect will be blunted. Strategies to overcome diuretic resistance include restriction of sodium intake, changes in dose, changes in timing, and combination diuretic therapy. DOI: http://dx.doi.org/10.3329/jdnmch.v17i1.12193 J. Dhaka National Med. Coll. Hos. 2011; 17 (01): 44-46

scholarly journals A perspective on diuretic resistance in chronic congestive heart failure

2017 ◽  
Vol 11 (10) ◽  
pp. 271-278 ◽  
Author(s):  
Niel Shah ◽  
Raef Madanieh ◽  
Mehmet Alkan ◽  
Muhammad U. Dogar ◽  
Constantine E. Kosmas ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Sodium Intake ◽  
Diuretic Therapy ◽  
Management Strategies ◽  
Chronic Congestive Heart Failure ◽  
Diuretic Resistance ◽  
Pump Failure ◽  
Complex Disorder ◽  
Development And Management

Chronic congestive heart failure (CHF) is a complex disorder characterized by inability of the heart to keep up the demands on it, followed by the progressive pump failure and fluid accumulation. Although the loop diuretics are widely used in heart failure (HF) patients, both pharmacodynamic and pharmacokinetic alterations are thought to be responsible for diuretic resistance in these patients. Strategies to overcome diuretic resistance include sodium intake restriction, changes in diuretic dose and route of administration and sequential nephron diuretic therapy. In this review, we discuss the definition, prevalence, mechanism of development and management strategies of diuretic resistance in HF patients.

Continuous Infusion of Furosemide in the Treatment of Patients with Congestive Heart Failure and Diuretic Resistance

1994 ◽  
Vol 38 (6) ◽  
pp. 362
Author(s):  
J. J. M. VAN MEYEL ◽  
P. SMITS ◽  
T. DORMAN ◽  
P. G. G. GERLAG ◽  
F. G. M. RUSSEL ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Continuous Infusion ◽  
Diuretic Resistance

Abstract 187: Loop Diuretic Therapy in Acute Decompensated Heart Failure among Premier Hospitals

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
Behnood Bikdeli ◽  
Kelly Strait ◽  
Kumar Dharmarajan ◽  
Chohreh Partovian ◽  
Nancy Kim ◽  
...  
Keyword(s):  
Heart Failure ◽  
Loop Diuretic ◽  
Acute Decompensated Heart Failure ◽  
Diuretic Therapy ◽  
Loop Diuretics ◽  
High Rate ◽  
Average Daily Dose ◽  
Duration Of Therapy ◽  
Daily Dose ◽  
Hospital Use

Background: Although loop diuretics are frequently used for patients with heart failure (HF), little is known about the variation in patterns of diuretic therapy in US hospitals. We sought to describe such treatment patterns among a diverse group of hospitals. Methods: We studied HF hospitalizations occurring during 2009-10 in Premier Inc. hospitals participating in a collaborative project to pool administrative and charge data, which includes information about drug types, average daily dose, and duration of therapy. We excluded hospitals with less than 25 HF hospitalizations. For ease of comparison, all diuretic doses were converted to bioequivalent doses of intravenous (IV) furosemide: 40mg IV furosemide ∼ 80mg oral furosemide ∼ 20mg (oral or IV) torsemide ∼ 1mg (oral or IV) bumetanide. Summary statistics were calculated. Results: Among 366 studied hospitals (264,675 HF hospitalizations), use of any loop diuretic had an interquartile range (IQR) from 92% to 96% (median: 94%). At the hospital level, the average daily dose IQR varied from 45mg to 64 mg (median: 55 mg) and the median duration of therapy was 4 days (IQR: 4 to 4; median: 4), as was the median length of stay. The IQR for use of furosemide varied from 89% to 94% (median: 92%), and its median average daily dose had an IQR from 40mg to 60 mg (median: 53 mg). Hospital use of bumetanide had an IQR from 2% to 11%, and hospital use of torsemide had an IQR from 0% to 4% (medians of 5% and 1%, respectively). The variation in median average daily dose for bumetanide and torsemide was greater than for furosemide (bumetanide IQR: 79mg to 127 mg, with median of 89 mg; torsemide IQR: 53mg to 120 mg, with median of 80 mg). Use of IV diuretics on the last day before home discharge had an IQR from 16% to 33% (median: 24%) across hospitals. Conclusion: US hospitals administer loop diuretics, particularly furosemide, to the vast majority of HF inpatients. The duration and daily dosage of therapy was similar across most hospitals. In contrast, a minority of hospitals used bumetanide and torsemide for several patients. The daily dosage of these agents showed more marked variation. We observed a high rate of intravenous diuretic use on the last day of hospitalization, with considerable variation across hospitals.

Refractory oedema in congestive heart failure: a contributory role of loop diuretics?

1995 ◽  
Vol 237 (2) ◽  
pp. 211-214 ◽  
Author(s):  
C. HALLER ◽  
P. SALBACH ◽  
H. KATUS ◽  
W. KÜBLER
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Loop Diuretics

Superiority of Long-Acting to Short-Acting Loop Diuretics in the Treatment of Congestive Heart Failure

2012 ◽  
Vol 76 (4) ◽  
pp. 833-842 ◽  
Author(s):  
Tohru Masuyama ◽  
Takeshi Tsujino ◽  
Hideki Origasa ◽  
Kazuhiro Yamamoto ◽  
Takashi Akasaka ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Loop Diuretics ◽  
Short Acting ◽  
Long Acting

Torsemide: A Pyridine-Sulfonylurea Loop Diuretic

1995 ◽  
Vol 29 (4) ◽  
pp. 396-402 ◽  
Author(s):  
Jamie S Blose ◽  
Kirkwood F Adams ◽  
J Herbert Patterson
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Renal Disease ◽  
English Language ◽  
Loop Diuretic ◽  
Antihypertensive Agents ◽  
Hepatic Disease ◽  
Loop Diuretics ◽  
Once Daily ◽  
Medline Search

Objective: To review the clinical pharmacology of torsemide and to compare it with currently available loop diuretics, particularly furosemide. Data Sources: An English-language MEDLINE search, 1985 to October 1994, was used to identify pertinent literature, including review articles. Data Extraction: Data from scientific literature were extracted, evaluated, and summarized for presentation. Pivotal and representative studies are discussed relating to the pharmacology, pharmacokinetics, and use of torsemide in patients with congestive heart failure, renal disease, hepatic disease, and hypertension. Data Synthesis: Torsemide is a loop diuretic of the pyridine-sulfonylurea class. The bioavailability of torsemide is approximately 80%, with little first-pass metabolism, and torsemide can be given without regard to meals. The serum concentration reaches its peak within 1 hour after oral administration and diuresis lasts approximately 6—8 hours. Torsemide is eliminated both hepatically (80%) and renally (20%) as unchanged drug with an elimination half-life of about 3.5 hours. Because of the high bioavailability, oral and intravenous doses are therapeutically equivalent. Torsemide, and other loop diuretics such as furosemide, are indicated for the treatment of edema associated with congestive heart failure, renal disease, and hepatic disease. They also are indicated for the treatment of hypertension alone or in combination with other antihypertensive agents. Depending on the indication, the recommended initial adult dosage of torsemide is between 5 and 20 mg once daily orally or intravenously. Special dosage adjustments in the elderly are not necessary. Conclusions: Torsemide is a loop diuretic similar to furosemide, with similar indications. Torsemide is characterized by good bioavailability and once-daily dosing and, compared with furosemide, provides generally equivalent therapeutic efficacy.

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