Diuretic Resistance in Advanced Heart failure: A Literature Review

Abstract

Background: Diuretic resistance is a common problem issue in acute decompensation of advanced heart failure Objective: In this review, we will discuss how to diagnose the advanced heart failure and the underlying mechanism of diuretic resistance in heart failure patients. We also describe pharmacologicalvand non-pharmaco-logical strategies to overcome this issue. Discussion: Advanced heart failure (HF) is used to characterize patients in HF with severe symptoms, recurrent decompensation and severe cardiac dysfunction. Most of HF hospitalization are due to signs and symptoms of fluidcoverload. Recurrent congestionccould worsen patients outcomes. Loop diuretics are recommended for thectreatmentcofkcongestionqinprHF patient. However,ndiuretic resistance is a common problem issue in acute decompensation of advanced chronic heart failure (ACHF) patients and established prognostic factor. The pathophysiology of diuretic resistance is very complex, and several etiologies mayabe involved. It derives from multiple factors, including reduced delivery of the diuretic to its luminal site of action, neurohormonal activation, tubular compensatory adaptation, and drug interactions Conclusion: Diuretic resistance has emerged as an independent factor behind worse HF patient outcomes, namely in-hospital worsening, early post-discharge mortality, and rehospitalizations. Once the diuretic resistance has been treated successfully, the treatment of advanced HF should be optimized in order to reduce further morbidity and mortality.