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Loop Diuretic Resistance in a Patient with Acute Heart Failure

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Cardiorenal Syndrome in Heart Failure

Abstract

Diuretic resistance complicating decongestion during acute heart failure hospitalization is an emerging research topic of interest. Herein, we discuss the issues prohibiting a universal definition for diuretic resistance and discuss the best metrics available to identify and prognosticate outcomes following diuretic resistance. We propose a resistance mechanism-based classification system for loop diuretic resistance: pre-nephron resistance, pre-loop of Henle resistance, loop of Henle resistance, and post-loop of Henle resistance. Within this classification system, we discuss the current relevance of historical paradigms of diuretic resistance from other patient populations and limitations in automatically applying these concepts to patients with heart failure. We provide a review of recent diuretic resistance research performed in specific heart failure cohorts and interpret these results in the context of historical literature. We conclude with a discussion of mechanism-based treatment options to restore diuretic efficacy.

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Authors and Affiliations

  1. Department of Pharmacy Practice, Lipscomb University College of Pharmacy, Nashville, TN, USA

    Zachary L. Cox

  2. Department of Pharmacy, Vanderbilt University Medical Center, Nashville, TN, USA

    Zachary L. Cox

  3. Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA

    Jeffrey M. Testani

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  1. Zachary L. Cox
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  2. Jeffrey M. Testani
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Correspondence to Jeffrey M. Testani .

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Editors and Affiliations

  1. Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA

    W. H. Wilson Tang

  2. Department of Internal Medicine, UZ Leuven, Leuven, Belgium

    Frederik H. Verbrugge

  3. Ziekenhuis Oost-Limburg, Genk University Hasselt, Genk, Belgium

    Wilfried Mullens

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Cox, Z.L., Testani, J.M. (2020). Loop Diuretic Resistance in a Patient with Acute Heart Failure. In: Tang, W., Verbrugge, F., Mullens, W. (eds) Cardiorenal Syndrome in Heart Failure. Springer, Cham. https://doi.org/10.1007/978-3-030-21033-5_11

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