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Pharmacologic and interventional paradigms of diuretic resistance in congestive heart failure: a narrative review

  • Nephrology - Review
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Abstract

Diuretic volume reduction continues to be the mainstay of congestive heart failure (CHF) management globally. However, diuretic resistance is a critical topic that lacks standardized evidence-based management guidelines accounting for mechanisms of diuretic resistance, renal function, and co-morbidities. Major healthcare utilization consequences result from this. The authors herein reconcile the definition of renal functional decline with emphasis on biomarker-driven assessment. Novel goal-directed treatment approaches are reviewed including hypertonic saline, acetazolamide, sodium-glucose transporter inhibition, sequential nephron blockade and Elabela-APJ axis targeting are reviewed, as well as percutaneous visceral splanchnic sympathectomy (converting a volume-focused to a distribution-focused paradigm).

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Acknowledgements

MK gratefully acknowledge use of the services and facilities of the Koc University Research Center for Translational Medicine (KUTTAM), funded by the Presidency of Turkey, Presidency of Strategy and Budget. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Presidency of Strategy and Budget.”

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This study was not funded by any Grant.

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Authors and Affiliations

  1. Department of Medicine, Koc University School of Medicine, Istanbul, Turkey

    Simge Acar, Sueda Sanli & Cinar Oztosun

  2. Division of Nephrology, Department of Internal Medicine, Suleyman Demirel University School of Medicine, Isparta, Turkey

    Baris Afsar

  3. Division of Vascular and Interventional Radiology, Department of Radiology, Duke University Medical Center, Durham, NC, USA

    Alan A. Sag

  4. Department of Cardiology, Toranomon Hospital, Tokyo, Japan

    Masanari Kuwabara

  5. Cardiovascular Center, St. Luke’s International Hospital, Tokyo, Japan

    Masanari Kuwabara

  6. Department of Nephrology, Grigore T. Popa’ University of Medicine, Iasi, Romania

    Adrian Covic

  7. Dialysis Unit, School of Medicine, IIS-Fundacion Jimenez Diaz, Universidad Autónoma de Madrid, Avd. Reyes Católicos 2, 28040, Madrid, Spain

    Alberto Ortiz

  8. Department of Medicine, Division of Nephrology, Koc University School of Medicine, Istanbul, 34010, Turkey

    Mehmet Kanbay

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  1. Simge Acar
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Contributions

Contributed substantially to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work: SA, CO, SS, BA, MK. Drafted the work or revised it critically for important intellectual content: AS, MK, AO, AC, MK. Approved the final version to be published: AC, AO, MK.

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Correspondence to Mehmet Kanbay.

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Acar, S., Sanli, S., Oztosun, C. et al. Pharmacologic and interventional paradigms of diuretic resistance in congestive heart failure: a narrative review. Int Urol Nephrol 53, 1839–1849 (2021). https://doi.org/10.1007/s11255-020-02704-7

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