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Edema Mechanisms in the Heart Failure Patient and Treatment Options

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Managing the Kidney when the Heart is Failing

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Abstract

The pathophysiology of sodium and water retention in heart failure is complex and marked by a unique interplay of hemodynamic and neurohumoral factors that evolve in tandem with progression of the underlying heart failure state. The sense of arterial underfilling signals the heart and prompts heart failure-related sodium and water retention. The level of neurohormonal activation, the scale of renal vasoconstriction, and the degree to which renal perfusion pressure is reduced arbitrate this process. When water retention exceeds that of sodium the end result is dilutional hyponatremia, which can present a particularly tricky treatment circumstance. The edema state can also moderate assorted aspects of the natriuretic response to diuretic therapy. The blunted response to diuretics in heart failure can also have disease-specific elements; however, diuretic response is more commonly influenced by the rate and extent of diuretic absorption, the time course of tubular delivery for a diuretic and loop diuretic-related hypertrophic structural changes localized to the distal tubule.

Originally published in Bakris, The Kidney in Heart Failure, ISBN: 978-1-4614-3693-5

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  1. Clinical Pharmacology and Hypertension, Virginia Commonwealth University Health System, Richmond, VA, 23298-0160, USA

    Domenic A. Sica

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  1. ASH Comprehensive Hypertension Center, Department of Medicine, University of Chicago Medical Center, 5841 S. Maryland Avenue, MC1027, Chicago, 60637, Illinois, USA

    George L. Bakris

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Sica, D.A. (2012). Edema Mechanisms in the Heart Failure Patient and Treatment Options. In: Bakris, G. (eds) Managing the Kidney when the Heart is Failing. Springer, Boston, MA. https://doi.org/10.1007/978-1-4614-3691-1_6

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