TITLE:
The use of diuretics in acute heart failure: Evidence based therapy?
AUTHORS:
Ali Vazir, Martin R. Cowie
KEYWORDS:
Acute Heart Failure; Diuretics; Diuretic Resistance; Ultrafiltration
JOURNAL NAME:
World Journal of Cardiovascular Diseases,
Vol.3 No.2A,
April
30,
2013
ABSTRACT: The evidence base for the use of diuretics in acute
heart failure is limited, with no large double-blind placebo-controlled
randomized trials. However, their use as a first line treatment of acute heart
failure is firmly established in clinical practice, and endorsed in clinical
guidelines. Loop diuretics are typically the first line diuretic strategy for
the treatment of acute heart failure. For patients with considerable fluid retention,
there is some evidence that initial treatment with continuous infusion or
boluses of high dose loop diuretic is superior to an initial lower dose
strategy. In patients who are diuretic resistant, the addition of an oral
thiazide or thiazide-like diuretic to induce sequential nephron blockade can
be beneficial. Intravenous low-dose dopamine has also been used to assist
diuresis and preserve renal function in such circumstances, but trials are
underway to confirm the clinical value of this agent. Mechanical ultrafiltration
has been used to treat patients with heart failure and fluid retention, but the
evidence base is not secure, and its place in clinical practice is yet to be established.