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

Acar S., Sanli S., Oztosun C., AFŞAR B., Sag A. A., Kuwabara M., ...More

INTERNATIONAL UROLOGY AND NEPHROLOGY, vol.53, no.9, pp.1839-1849, 2021 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Review
  • Volume: 53 Issue: 9
  • Publication Date: 2021
  • Doi Number: 10.1007/s11255-020-02704-7
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, BIOSIS, EMBASE, Gender Studies Database, MEDLINE
  • Page Numbers: pp.1839-1849
  • Keywords: Acute kidney injury, Diuretic, Heart failure, Hypertonic saline, Hypervolemia
  • Süleyman Demirel University Affiliated: Yes


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).