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Combinational Diuretics in Heart Failure

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Abstract

Purpose of Review

Diuretics are the cornerstone therapy for acute heart failure (HF) and congestion. Patients chronically exposed to loop diuretics may develop diuretic resistance as a consequence of nephron remodelling, and the combination of diuretics will be necessary to improve diuretic response and achieve decongestion. This review integrates data from recent research and offers a practical approach to current pharmacologic therapies to manage congestion in HF with a focus on combinational therapy.

Recent Findings

Until recently, combined diuretic treatment was based on observational studies and expert opinion. Recent evidence from clinical trials has shown that combined diuretic treatment can be started earlier without escalating the doses of loop diuretics with an adequate safety profile.

Summary

Diuretic combination is a promising strategy for overcoming diuretic resistance in HF. Further studies aiming to get more insights into the pathophysiology of diuretic resistance and large clinical trials confirming the safety and efficacy over standard diuretics regimens are warranted.

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Data Availability

No datasets were generated or analyzed during the current study.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Authors and Affiliations

  1. Internal Medicine Department, Hospital d’Olot I Comarcal de La Garrotxa, Avinguda Dels Països Catalans 86, 17800, Olot, Girona, Spain

    Joan Carles Trullàs

  2. Tissue Repair and Regeneration Laboratory (TR2Lab), Institut de Recerca I Innovació en Ciències de La Vida I de La Salut a La Catalunya Central (IrisCC), Ctra. de Roda, 70 08500 Vic, Barcelona, Spain

    Joan Carles Trullàs

  3. Internal Medicine Department, Hospital Universitario de Getafe, Carretera de Madrid - Toledo, Km 12,500, 28905, Madrid, Spain

    Jesús Casado

  4. Cardiology Department, Hospital Universitario Puerta de Hierro Majadahonda (IDIPHISA), Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain

    Marta Cobo-Marcos

  5. Internal Medicine Department, Hospital Universitari de Bellvitge, IDIBELL, Carrer de La Feixa Llarga S/N, L’Hospitalet de Llobregat, 08907, Barcelona, Spain

    Francesc Formiga

  6. Internal Medicine Department, Heart Failure Unit, Hospital Universitari Arnau de Villanova, Institut de Recerca Biomédica (IRBLleida), Avinguda Alcalde Rovira Roure, 80, 25198, Lleida, Spain

    José Luís Morales-Rull

  7. Cardiology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain

    Julio Núñez

  8. Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain

    Julio Núñez

  9. Department of Medicine, University of Valencia, Valencia, Spain

    Julio Núñez

  10. Centro de Investigación Biomédica en Red - Cardiovascular (CIBER-CV), Madrid, Spain

    Julio Núñez

  11. Internal Medicine Department, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, M-607, 9, 100, 28034, Madrid, Spain

    Luís Manzano

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JCT wrote the main manuscript text. JCT and JLM prepared the figures. All authors reviewed the manuscript and approved the final version.

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Correspondence to Joan Carles Trullàs.

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JC received consulting and lecture fees from AstraZeneca, Boehringer Ingelheim, Novartis and Vifor Pharma (outside the submitted work). MCM reports personal fees or advisory boards from AstraZeneca, Boehringer Ingelheim, Bayer, Novartis, NovoNordisk, Rovi, and Vifor Pharma (outside the submitted work). JLMR received consulting and lecture fees from AstraZeneca, Boehringer Ingelheim, Esteve and Zambon. JN reports personal fees or advisory boards from Alleviant, AstraZeneca, Boehringer Ingelheim, Bayer, Novartis, NovoNordisk, Pfizer, Rovi, and Vifor Pharma (outside the submitted work). LM reports personal fees or advisory boards from AstraZeneca, Boehringer Ingelheim, Lilly, Bayer, Novartis and Rovi (outside the submitted work). JCT and FF declare that they have no conflict of interest.

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Trullàs, J.C., Casado, J., Cobo-Marcos, M. et al. Combinational Diuretics in Heart Failure. Curr Heart Fail Rep (2024). https://doi.org/10.1007/s11897-024-00659-9

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