Register
Forgot your password?

Diuretic therapy for heart failure:focus on resistance to diuretics

Authors: Bektur Sh. Berdibekov

Company: Bakoulev National Medical Research Center for Cardiovascular Surgery of Ministry of Health of the Russian Federation, Rublevskoe shosse, 135, Moscow, 121552, Russian Federation

For correspondence:  Sign in or register.

Type:  Reviews


DOI: https://doi.org/10.24022/1997-3187-2018-12-4-366-382

For citation: Berdibekov B.Sh. Diuretic therapy for heart failure: focus on resistance to diuretics. Creative Cardiology. 2018; 12 (4): 366–82 (in Russ.). DOI: 10.24022/1997-3187-2018-12-4-366-382

Received / Accepted:  19.10.2018/07.11.2018

Keywords: heart failure diuretics resistance to diuretic therapy causes and mechanisms coping strategies

Full text:  

 

Abstract

Most patients with acute decompensation of heart failure have certain symptoms and/or signs of fluid accumulation in the body. One of the main methods of treatment in this case is diuretic therapy. However, some patients may have varying degrees of resistance to diuretic therapy. There are many reasons for resistance to diuretics, it is the determination of the cause of diuretic resistance that can help the clinician in choosing an appropriate strategy for restoring the diuretic response. Although this condition is often found in clinical practice, there is no consensus definition, and recommendations for an optimal therapeutic approach remain limited. In this review, we discuss the current pharmacological principles of diuretic therapy, the causes and mechanisms of resistance to diuretics, and various approaches to overcome resistance to diuretics based on the latest clinical studies.

References

  1. Hunt S.A., Abraham W.T., Chin M.H. 2009 focused update incorporated into the ACC/AHA 2005 guidelines for the diagnosis and management of heart failure in adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J. Am. Coll. Cardiol. 2009; 53: 1–90. DOI: 10.1161/CIRCULATIONAHA.109.192065
  2. Adams K.F., Jr., Fonarow G.C., Emerman C.L. et al. Characteristics and outcomes of patients hospitalized for heart failure in the United States: rationale, design, and preliminary observations from the first 100,000 cases in the Acute Decompensated Heart Failure National Registry (ADHERE). Am. Heart J. 2005; 149: 209–16. DOI: 10,1016/j.ahj.2004.08.005
  3. Ponikowski P., Adriaan A., Voors S.D. et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur. Heart J. 2016; 37 (27): 2129–200. DOI: 10.1093/EURHEARTJ/EHW128
  4. Somasekharan S., Tanis J., Forbush B. Loop diuretic and ion-binding residues revealed by scanning mutagenesis of transmembrane helix 3 (TM3) of Na-K-Cl cotransporter (NKCC1). J. Biol. Chem. 2012; 287: 17308–17. DOI: 10.1074/jbc.M112.356014
  5. Ikeda K., Oshima, T., Hidaka H., Takasaka T. Molecular and clinical implications of loop diuretic ototoxicity. Hearing Res. 1997; 107: 1–8.
  6. Castrop H., Lorenz J.N., Hansen P.B. et al. Contribution of the basolateral isoform of the Na- K-2Cl- cotransporter (NKCC1/BSC2) to renin secretion. Am. J. Physiol. Renal. Physiol. 2005; 289: 1185–92. DOI: 10.1152/ajprenal.00455.2004
  7. Krämer B.K., Schweda F., Riegger G.A. Diuretic treatment and diuretic resistance in heart failure. Am. J. Med. 1999; 106 (1): 90–6.
  8. Kumar D., Bagarhatta R. Fractional excretion of sodium and its association with prognosis of decompensated heart failure patients. JCDR. 2015; 9 (4): OC01–3. DOI: 10.7860/JCDR/2015/11532.5736
  9. Epstein M., Lepp B.A., Hoffman D.S. et al. Potentiation of furosemide by metolazone in refractory edema. Curr. Ther. Res. 1977; 21: 656–67.
  10. Neuberg G.W., Miller A.B., O’Connor C.M. et al. Diuretic resistance predicts mortality in patients with advanced heart failure. Am. Heart J. 2002; 144 (1): 31–8. DOI: 10.1067/mhj.2002.123144
  11. Vargo D.L., Kramer W.G., Black P.K. et al. Bioavailability, pharmacokinetics, and pharmacodynamics of torsemide and furosemide in patients with congestive heart failure. Clin. Pharmacol. Ther. 1995; 57: 601–9.
  12. Uwai Y., Saito H., Hashimoto Y. et al. Interaction and transport of thiazide diuretics, loop diuretics, and acetazolamide via rat renal organic anion transporter rOAT1. J. Pharmacol. Exp. Ther. 2000; 295: 261–5.
  13. Ellison D.H., Felker G.M. Diuretic treatment in heart failure. N. Engl. J. Med. 2017; 377 (20): 1964–75. DOI: 10.1056/NEJMra1703100
  14. Kaissling B., Bachmann S., Kriz W. Structural adaptation of the distal convoluted tubule to prolonged furosemide treatment. Am. J. Physiol. 1985; 248: 374–81.
  15. Abdallah J.G., Schrier R.W., Edelstein C., Jennings S.D., Wyse B., Ellison D.H. Loop diuretic infusion increases thiazide-sensitive Na(+)/Cl(–)-cotransporter abundance: role of aldosterone. J. Am. Soc. Nephrol. 2001; 12: 1335–41.
  16. Muther R.S., Potter D.M., Bennett W.M. Aspirininduced depression of glomerular filtration rate in normal humans, role of sodium balance. Ann. Intern. Med. 1981; 94: 317–21.
  17. Мышляева Т.О., Постникова С.Л., Кисляк О.А. Хроническая сердечная недостаточность у женщин. Лечебное дело. 2018; 2: 59–64. DOI: 10.24411/2071-5315-2018-12003 / Myshlyaeva T.O., Postnikova S.L., Kislyak O.A. Chronic heart failure in women. Medical Care. 2018; 2: 59–64. DOI: 10.24411/2071-5315-2018-12003 (in Russ.). Lindenfeld J., Albert N.M., Boehmer J.P. et al. HFSA 2010 Comprehensive heart failure practice guideline. J. Card. Fail. 2010; 16 (6): e1–194. DOI: 10.1016/j.cardfail.2010.04.004
  18. Yancy C.W., Jessup M., Bozkurt B. et al. 2013 ACCF/AHA Guideline for the management of heart failure: a report of the American College of Cardiology foundation/American Heart Association task force on practice guidelines. Circulation. 2013; 128 (16): 1810–52. DOI: 10.1161/CIR.0b013e31829e8807
  19. Zachary L.C., Lenihan D.J. Loop diuretic resistance in heart failure: resistance etiology–based strategies to restoring diuretic efficacy. J. Card. Fail. 20 (8): 611–22. DOI: 10.1016/j.cardfail.2014.05.007
  20. De Bruyne L.K. Mechanisms and management of diuretic resistance in congestive heart failure. Postgrad. Med. J. 2003; 79: 268–71.
  21. Ellison D.H. Diuretic resistance: physiology and therapeutics. Semin. Nephrol. 1999; 19: 581–97.
  22. Dormans T.J., van Meyel J.M., Gerlag P.G. et al. Diuretic efficacy of high dose furosemide in severe heart failure: bolus injection versus continuous infusion. J. Am. Coll. Cardiol. 1996; 28: 376–82. DOI: 10.1016/0735-1097 (96)00161-1
  23. Dormans T.P. van Meyel J.J., Gerlag P.G.G. et al. Diuretic efficacy of high dose furosemide in severe heart failure: bolus injection versus continuous infusion. J. Am. Coll. Cardiol. 1996; 28 (2): 376–82. DOI: 10.1016/0735-1097(96)00161-1
  24. Felker G.M., Lee K.L., Bull D.A. et al. Diuretic strategies in patients with acute decompensated heart failure. N. Engl. J. Med. 2011; 364: 797–805. DOI: 10.1056/NEJMoa1005419
  25. Ryback L.P. Ototoxicity of loop diuretics. Otolaryngol. Clin. North. Am. 1993; 26: 829–44.
  26. Kuchar D.L., O’Rourke M.F. High-dose furosemide in refractory cardiac failure. Eur. Heart J. 1985; 6: 954–8.
  27. Gerlag P.G., van Meijel J.J. High-dose furosemide in the treatment of refractory congestive heart failure. Arch. Intern. Med. 1988; 148: 286–91.
  28. Huang C.M., Atkinson A.J., Jr., Levin M., Levin N.W., Quintanilla A. Pharmacokinetics of furosemide in advanced renal failure. Clin. Pharmacol. Ther. 1974; 16: 659–66.
  29. Cosin J., Diez J., TORIC investigators. Torasemide in chronic heart failure: results of the TORIC study. Eur. J. Heart Fail. 2002; 4 (4); 507–13.
  30. Lorenz R.A., Elwell R.J. Pre-dosing metolazone with loop diuretic combination regimens. Nephrol. Nurs. J. 2006; 33: 78–9.
  31. Jentzer J.C., DeWald T.A., Hernandez A.F. Combination of loop diuretics with thiazide-type diuretics in heart failure. J. Am. Coll. Cardiol. 2010; 56: 1527–34.
  32. Dormans T.P.J., Gerlag P.G. Combination of highdose furosemide and hydrochlorothiazide in the treatment of refractory congestive heart failure. Eur. Heart J. 1996; 17: 1867–74.
  33. Trulla`s J.C., Morales-Rull J.L., Casado J. et al. Rationale and design of the “Safety and Efficacy of the Combination of Loop with Thiazide-type Diuretics in Patients with Decompensated Heart Failure (CLOROTIC) trial”: A double-blind, randomized, placebo-controlled study to determine the effect of combined diuretic therapy (loop diuretics with thiazide-type diuretics) among patients with decompensated heart failure. J. Card. Fail. 2016; 22 (7): 529–36. DOI: 10.1016/j.cardfail.2015.11.003
  34. Knauf H., Mutschler E. Low-dose segmental blockade of the nephron rather than high-dose diuretic monotherapy. Eur. J. Clin. Pharmacol. 1993; 44 (1): 63–8.
  35. Мареев В.Ю., Агеев Ф.Т., Арутюнов Г.П. и др. Национальные рекомендации ОССН, РКО и РНМОТ по диагностике и лечению ХСН (четвертый пересмотр). Журнал Сердечная Недостаточность. 2013; 14 (7): 419–26 / Mareev V.Yu., Ageev F.T., Arutyunov G.P. et al. National recommendations of SHFS, RCS on diagnosis and treatment of CHF (fourth revision); Russian Heart Failure Journal. 2013; 14 (7): 419–26 (in Russ.).
  36. Adamson R., Swenson E.R. Acetazolamide usage in severe chronic obstructive pulmonary disease: pros and cons. Ann. Am. Thorac. Soc. 2017: 14 (7): 1086–93. DOI: 10.1513/AnnalsATS.201701-016FR
  37. Turagarm M.K., Velagapudi P., Kalra A.S. et al. Outcomes of furosemide-manitol infusion in hospitalized patients with heart failure: an observational singlecenter cohort study of 122 patients. Int. J. Cardiol. 2011; 151: 232–4. DOI: 10.1016/j.ijcard.2011.06.044
  38. Santos J., Planas R., Pardo A. et al. Spironolactone alone or in combination with furosemide in the treatment of moderate ascites in nonazotemic cirrhosis. A randomized comparative study of efficacy and safety. J. Hepatol. 2003; 39: 187–92.
  39. Giamouzis G., Butler J., Starling R.C. et al. Impact of dopamine infusion on renal function in hospitalized heart failure patients: results of the Dopamine in Acute Decompensated Heart Failure (DAD-HF) Trial. J. Card Fail. 2010; 16: 922–30. DOI: 10.1016/j.cardfail.2010.07.246
  40. Colucci W.S., Elkayam U., Horton D.P. et al. Intravenous nesiritide, a natriuretic peptide, in the treatment of decompensated congestive heart failure. N. Engl. J. Med. 2000; 343: 246–53. 42. O’Connor C.M., Starling R.C., Hernandez A.F. et al. Effect of nesiritide in patients with acute decompensated heart failure. N. Engl. J. Med. 2011; 365: 32–43. DOI: 10.1056/NEJMoa1100171
  41. Chen H.H., Anstrom K.J., Givertz M.M. et al. Low-dose dopamine or low-dose nesiritide in acute heart failure with renal dysfunction: the ROSE acute heart failure randomized trial. JAMA. 2013; 310: 2533–43. DOI: 10.1001/jama.2013.282190 Wan S.H., Stevens S.R., Borlaug B.A. et al. Differential response to low-dose dopamine or low-dose nesiritide in acute heart failure with reduced or preserved ejection fraction: results from the ROSE AHF Trial (Renal Optimization Strategies Evaluation in Acute Heart Failure). Circ. Heart Fail. 2016; 9 (8): e002593. DOI: 10.1161/CIRCHEARTFAILURE.115.002593
  42. De Vecchis R., Esposito C., Ariano C., Cantatrione S. Hypertonic saline plus i.v. furosemide improve renal safety profile and clinical outcomes in acute decompensated heart failure: A metaanalysis of the literature. Herz. 2015; 40 (3): 423–35. DOI: 10.1007/s00059-013-4041-6
  43. Inoue M., Okajima K., Itoh K. et al. Mechanism of furosemide resistance in analbuminemic rats and hypoalbuminemic patients. Kidney Int. 1987; 32: 198–203.
  44. Elwell R.J., Spencer A.P., Eisele G. Combined furosemide and human albumin treatment for diuretic-resistant edema. Ann. Pharmacother. 2003; 37: 695–700.
  45. Georgios K.D., Mascari P., Ettunsi R., Gray A.W. Co-administration of furosemide with albumin for overcoming diuretic resistance in patients with hypoalbuminemia: a meta-analysis. J. Crit. Care. 2014: 29 (2): 253–9. DOI: 10.1016/j.jcrc.2013.10.004
  46. Rusinaru D., Tribouilloy C., Berry C. et al. Relationship of serum sodium concentration to mortality in a wide spectrum of heart failure patients with preserved and with reduced ejection fraction: an individual patient data meta-analysis: Meta-Analysis Global Group in Chronic heart failure (MAGGIC). Eur. J. Heart Fail. 2012; 14: 1139–46. DOI: 10.1093/eurjhf/hfs099
  47. Pang P.S., Konstam M.A., Krasa H.B. et al. Effects of tolvaptan on dyspnoea relief from the EVEREST trials. Eur. Heart J. 2009; 30: 2233–40. DOI: 10.1093/eurheartj/ehp253
  48. Felker G.M., Mentz R.J., Cole R.T. et al. Efficacy and safety of tolvaptan in patients hospitalized with acute heart failure. J. Am. Coll. Cardiol. 2017; 69: 1399–406. DOI: 10.1016/j.jacc.2016.09.004

About Authors

Bektur Sh. Berdibekov, Postgraduate, orcid.org/0000-0001-7717-4971

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Sort by