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Bart, B.A., Goldsmith, S.R., Lee, K.L., Givertz, M.M., O’Connor, C.M., Bull, D.A., et al. (2012) Ultrafiltration in decompensated heart failure with cardiorenal syndrome. The New England Journal of Medicine, 367, 2296-2304. doi:10.1056/NEJMoa1210357

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• 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.