Response letter to Shetty and Shetty’s reply about DRAIN trial
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In 1988, Serena Bergerone, MD, published one of the first studies on ultrafiltration in advanced heart failure patients . After more than 30 years, we still discuss about optimal dosing and method of delivery of diuretics in patients with acute heart failure. After more than 500 publications about the use of furosemide in acute heart failure, a consensus is still lacking. In particular, the DOSE trial did not overcome all the gaps in evidence. Every physician committed to acute heart failure treatment could easily tell the reason. Acute heart failure is a manifold syndrome and patients admitted for acute heart failure should be thoroughly evaluated to tailor the best treatment. Response to diuretics may depend on many elements such as the degree of congestion (with particular attention to abdominal congestion  and dilutional hyponatremia ), the right ventricular function (with particular attention to right atrial pressure and tricuspid regurgitation ), the perfusion...
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