Diuretic Therapy for Patients With Heart Failure JACC State-of-the-Art Review

被引:261
作者
Felker, G. Michael [1 ,2 ]
Ellison, David H. [3 ,4 ,5 ]
Mullens, Wilfried [6 ,7 ]
Cox, Zachary L. [8 ,9 ]
Testani, Jeffrey M. [10 ]
机构
[1] Duke Univ, Sch Med, Duke Clin Res Inst, Durham, NC USA
[2] Duke Univ, Sch Med, Div Cardiol, Durham, NC USA
[3] Oregon Clin & Translat Res Inst, Portland, OR USA
[4] Oregon Hlth & Sci Univ, Portland, OR 97201 USA
[5] VA Portland Hlth Care Syst, Portland, OR USA
[6] Ziekenhuis Oost Limburg, Dept Cardiol, Genk, Belgium
[7] Hasselt Univ, Fac Med & Life Sci, Biomed Res Inst, Diepenbeek, Belgium
[8] Lipscomb Univ, Dept Pharm Practice, Coll Pharm, Nashville, TN USA
[9] Vanderbilt Univ, Med Ctr, Dept Pharm, Nashville, TN USA
[10] Yale Univ, Sch Med, Dept Internal Med, Sect Cardiovasc Med, New Haven, CT 06510 USA
关键词
congestion; diuretics; heart failure; pharmacology; HIGH-DOSE FUROSEMIDE; RENAL VASCULAR-RESISTANCE; CORTICAL COLLECTING DUCT; SALINE SOLUTION INFUSION; THICK ASCENDING LIMB; LOOP DIURETICS; BLOOD-PRESSURE; COTRANSPORTER ABUNDANCE; NA-K-2CL COTRANSPORTER; VENOUS PRESSURE;
D O I
10.1016/j.jacc.2019.12.059
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Expansion of extracellular fluid volume is central to the pathophysiology of heart failure. Increased extracellular fluid leads to elevated intracardiac filling pressures, resulting in a constellation of signs and symptoms of heart failure referred to as congestion. Loop diuretics are one of the cornerstones of treatments for heart failure, but in contrast to other therapies, robust clinical trial evidence to guide the use of diuretics is sparse. A nuanced understanding of renal physiology and diuretic pharmacokinetics is essential for skillful use of diuretics in the management of heart failure in both the inpatient and outpatient settings. Diuretic resistance, defined as an inadequate quantity of natriuresis despite an adequate diuretic regimen, is a major clinical challenge that generally portends a poor prognosis. In this review, the authors discuss the fundamental mechanisms and physiological principles that underlie the use of diuretic therapy and the available data on the optimal use of diuretics. (C) 2020 by the American College of Cardiology Foundation.
引用
收藏
页码:1178 / 1195
页数:18
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