Advertisement

Diuretics in Heart Failure

  • Sarat Kuppachi
  • Mony Fraer
Chapter

Abstract

Heart failure (HF) is a rapidly growing global pandemic. Despite advances in treatment, morbidity and mortality rates in the post-discharge period after an admission for acute decompensated heart failure (ADHF) remain unacceptably high. The mainstay of first line treatment is centered on diuretic therapy and fluid management. This chapter discusses the interactions between heart and kidney in HF, and focuses on the management of fluid overload. We discuss the mechanisms of diuretic resistance and its treatment. Recent trials performed on diuretic dosing and the comparisons of pharmacologic therapy to ultrafiltration are also reviewed.

Keywords

Heart failure Diuretics Cardiorenal syndrome Loop diuretics Thiazide diuretics Potassium sparing diuretics Ultrafiltration Diuretic resistance Combination diuretic strategies 

References

  1. 1.
    Writing Group M, Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, et al. Heart disease and stroke statistics-2016 update: a report from the American Heart Association. Circulation. 2016;133(4):e38–360.CrossRefGoogle Scholar
  2. 2.
    Heidenreich PA, Trogdon JG, Khavjou OA, Butler J, Dracup K, Ezekowitz MD, et al. Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association. Circulation. 2011;123(8):933–44.CrossRefPubMedGoogle Scholar
  3. 3.
    Heart Failure Society of America, Lindenfeld J, Albert NM, Boehmer JP, Collins SP, Ezekowitz JA, et al. HFSA 2010 comprehensive heart failure practice guideline. J Card Fail. 2010;16(6):e1–194.CrossRefGoogle Scholar
  4. 4.
    Hillege HL, Girbes AR, de Kam PJ, Boomsma F, de Zeeuw D, Charlesworth A, et al. Renal function, neurohormonal activation, and survival in patients with chronic heart failure. Circulation. 2000;102(2):203–10.CrossRefPubMedGoogle Scholar
  5. 5.
    Schrier RW. Body fluid volume regulation in health and disease: a unifying hypothesis. Ann Intern Med. 1990;113(2):155–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Kramer RS, Mason DT, Braunwald E. Augmented sympathetic neurotransmitter activity in the peripheral vascular bed of patients with congestive heart failure and cardiac norepinephrine depletion. Circulation. 1968;38(4):629–34.CrossRefPubMedGoogle Scholar
  7. 7.
    Cohn JN, Levine TB, Olivari MT, Garberg V, Lura D, Francis GS, et al. Plasma norepinephrine as a guide to prognosis in patients with chronic congestive heart failure. N Engl J Med. 1984;311(13):819–23.CrossRefPubMedGoogle Scholar
  8. 8.
    Schrier RW. Role of diminished renal function in cardiovascular mortality: marker or pathogenetic factor? J Am Coll Cardiol. 2006;47(1):1–8.CrossRefPubMedGoogle Scholar
  9. 9.
    Weber KT. Aldosterone in congestive heart failure. N Engl J Med. 2001;345(23):1689–97.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Blankstein R, Bakris GL. Renal hemodynamic changes in heart failure. Heart Fail Clin. 2008;4(4):411–23.CrossRefPubMedGoogle Scholar
  11. 11.
    Lee WH, Packer M. Prognostic importance of serum sodium concentration and its modification by converting-enzyme inhibition in patients with severe chronic heart failure. Circulation. 1986;73(2):257–67.CrossRefPubMedGoogle Scholar
  12. 12.
    Zeidel ML, Kikeri D, Silva P, Burrowes M, Brenner BM. Atrial natriuretic peptides inhibit conductive sodium uptake by rabbit inner medullary collecting duct cells. J Clin Invest. 1988;82(3):1067–74.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Henry JP, Gauer OH, Reeves JL. Evidence of the atrial location of receptors influencing urine flow. Circ Res. 1956;4(1):85–90.CrossRefPubMedGoogle Scholar
  14. 14.
    Forman DE, Butler J, Wang Y, Abraham WT, O’Connor CM, Gottlieb SS, et al. Incidence, predictors at admission, and impact of worsening renal function among patients hospitalized with heart failure. J Am Coll Cardiol. 2004;43(1):61–7.CrossRefPubMedGoogle Scholar
  15. 15.
    Gottlieb SS, Abraham W, Butler J, Forman DE, Loh E, Massie BM, et al. The prognostic importance of different definitions of worsening renal function in congestive heart failure. J Card Fail. 2002;8(3):136–41.CrossRefPubMedGoogle Scholar
  16. 16.
    Firth JD, Raine AE, Ledingham JG. Raised venous pressure: a direct cause of renal sodium retention in oedema? Lancet. 1988;1(8593):1033–5.CrossRefPubMedGoogle Scholar
  17. 17.
    Sarraf M, Masoumi A, Schrier RW. Cardiorenal syndrome in acute decompensated heart failure. Clin J Am Soc Nephrol. 2009;4(12):2013–26.CrossRefPubMedGoogle Scholar
  18. 18.
    Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Drazner MH, 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. J Am Coll Cardiol. 2013;62(16):e147–239.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Brater DC. Diuretic therapy. N Engl J Med. 1998;339(6):387–95.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Rose BD. Diuretics. Kidney Int. 1991;39(2):336–52.CrossRefPubMedGoogle Scholar
  21. 21.
    Amsler K, Kinne R. Photoinactivation of sodium-potassium-chloride cotransport in LLC-PK1/Cl 4 cells by bumetanide. Am J Phys. 1986;250(5 Pt 1):C799–806.CrossRefGoogle Scholar
  22. 22.
    Struthers A, Krum H, Williams GH. A comparison of the aldosterone-blocking agents eplerenone and spironolactone. Clin Cardiol. 2008;31(4):153–8.CrossRefPubMedGoogle Scholar
  23. 23.
    Preisig PA, Toto RD, Alpern RJ. Carbonic anhydrase inhibitors. Ren Physiol. 1987;10(3–4):136–59.PubMedGoogle Scholar
  24. 24.
    Stewart JH, Edwards KD. Clinical comparison of frusemide with bendrofluazide, mersalyl, and ethacrynic acid. Br Med J. 1965;2(5473):1277–81.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Crawford RJ, Allman S, Gibson W, Kitchen S, Richards HH. A comparative study of frusemide-amiloride and cyclopenthiazide-potassium chloride in the treatment of congestive cardiac failure in general practice. J Int Med Res. 1988;16(2):143–9.CrossRefPubMedGoogle Scholar
  26. 26.
    Felker GM, Lee KL, Bull DA, Redfield MM, Stevenson LW, Goldsmith SR, et al. Diuretic strategies in patients with acute decompensated heart failure. N Engl J Med. 2011;364(9):797–805.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Hsiao R, Greenberg B. Contemporary treatment of acute heart failure. Prog Cardiovasc Dis. 2016;58(4):367–78.CrossRefPubMedGoogle Scholar
  28. 28.
    Wilcox CS, Mitch WE, Kelly RA, Skorecki K, Meyer TW, Friedman PA, et al. Response of the kidney to furosemide. I. Effects of salt intake and renal compensation. J Lab Clin Med. 1983;102(3):450–8.PubMedGoogle Scholar
  29. 29.
    Hasselblad V, Gattis Stough W, Shah MR, Lokhnygina Y, O’Connor CM, Califf RM, et al. Relation between dose of loop diuretics and outcomes in a heart failure population: results of the ESCAPE trial. Eur J Heart Fail. 2007;9(10):1064–9.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Dormans TP, van Meyel JJ, Gerlag PG, Tan Y, Russel FG, Smits P. Diuretic efficacy of high dose furosemide in severe heart failure: bolus injection versus continuous infusion. J Am Coll Cardiol. 1996;28(2):376–82.CrossRefPubMedGoogle Scholar
  31. 31.
    Salvador DR, Rey NR, Ramos GC, Punzalan FE. Continuous infusion versus bolus injection of loop diuretics in congestive heart failure. Cochrane Database Syst Rev. 2005;3:CD003178.Google Scholar
  32. 32.
    Wilcox CS. New insights into diuretic use in patients with chronic renal disease. J Am Soc Nephrol. 2002;13(3):798–805.PubMedGoogle Scholar
  33. 33.
    Howard PA, Dunn MI. Aggressive diuresis for severe heart failure in the elderly. Chest. 2001;119(3):807–10.CrossRefPubMedGoogle Scholar
  34. 34.
    Sica DA. Metolazone and its role in edema management. Congest Heart Fail. 2003;9(2):100–5.CrossRefPubMedGoogle Scholar
  35. 35.
    Dickstein K, Cohen-Solal A, Filippatos G, McMurray JJ, Ponikowski P, Poole-Wilson PA, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur Heart J. 2008;29(19):2388–442.CrossRefPubMedGoogle Scholar
  36. 36.
    Wollam GL, Tarazi RC, Bravo EL, Dustan HP. Diuretic potency of combined hydrochlorothiazide and furosemide therapy in patients with azotemia. Am J Med. 1982;72(6):929–38.CrossRefPubMedGoogle Scholar
  37. 37.
    McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Bohm M, Dickstein K, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2012;33(14):1787–847.CrossRefGoogle Scholar
  38. 38.
    Zannad F, McMurray JJ, Krum H, van Veldhuisen DJ, Swedberg K, Shi H, et al. Eplerenone in patients with systolic heart failure and mild symptoms. N Engl J Med. 2011;364(1):11–21.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Effectiveness of spironolactone added to an angiotensin-converting enzyme inhibitor and a loop diuretic for severe chronic congestive heart failure (the Randomized Aldactone Evaluation Study [RALES]). Am J Cardiol. 1996;78(8):902–7.Google Scholar
  40. 40.
    van Vliet AA, Donker AJ, Nauta JJ, Verheugt FW. Spironolactone in congestive heart failure refractory to high-dose loop diuretic and low-dose angiotensin-converting enzyme inhibitor. Am J Cardiol. 1993;71(3):21A–8A.CrossRefPubMedGoogle Scholar
  41. 41.
    Ferreira JP, Santos M, Almeida S, Marques I, Bettencourt P, Carvalho H. Mineralocorticoid receptor antagonism in acutely decompensated chronic heart failure. Eur J Intern Med. 2014;25(1):67–72.CrossRefPubMedGoogle Scholar
  42. 42.
    Adams KF Jr, Fonarow GC, Emerman CL, LeJemtel TH, Costanzo MR, Abraham WT, 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(2):209–16.CrossRefPubMedGoogle Scholar
  43. 43.
    Ellison DH. Diuretic therapy and resistance in congestive heart failure. Cardiology. 2001;96(3–4):132–43.CrossRefPubMedGoogle Scholar
  44. 44.
    Vargo DL, Kramer WG, Black PK, Smith WB, Serpas T, Brater DC. Bioavailability, pharmacokinetics, and pharmacodynamics of torsemide and furosemide in patients with congestive heart failure. Clin Pharmacol Ther. 1995;57(6):601–9.CrossRefPubMedGoogle Scholar
  45. 45.
    Brater DC, Day B, Burdette A, Anderson S. Bumetanide and furosemide in heart failure. Kidney Int. 1984;26(2):183–9.CrossRefPubMedGoogle Scholar
  46. 46.
    Uwai Y, Saito H, Hashimoto Y, Inui KI. Interaction and transport of thiazide diuretics, loop diuretics, and acetazolamide via rat renal organic anion transporter rOAT1. J Pharmacol Exp Ther. 2000;295(1):261–5.PubMedGoogle Scholar
  47. 47.
    Jackson CE, Solomon SD, Gerstein HC, Zetterstrand S, Olofsson B, Michelson EL, et al. Albuminuria in chronic heart failure: prevalence and prognostic importance. Lancet. 2009;374(9689):543–50.CrossRefPubMedGoogle Scholar
  48. 48.
    Hesse B, Parving HH, Lund-Jacobsen H, Noer I. Transcapillary escape rate of albumin and right atrial pressure in chronic congestive heart failure before and after treatment. Circ Res. 1976;39(3):358–62.CrossRefPubMedGoogle Scholar
  49. 49.
    Kim EJ, Lee MG. Pharmacokinetics and pharmacodynamics of intravenous bumetanide in mutant Nagase analbuminemic rats: importance of globulin binding for the pharmacodynamic effects. Biopharm Drug Dispos. 2001;22(4):147–56.CrossRefPubMedGoogle Scholar
  50. 50.
    Sweet DH, Bush KT, Nigam SK. The organic anion transporter family: from physiology to ontogeny and the clinic. Am J Physiol Renal Physiol. 2001;281(2):F197–205.CrossRefPubMedGoogle Scholar
  51. 51.
    Loon NR, Wilcox CS, Unwin RJ. Mechanism of impaired natriuretic response to furosemide during prolonged therapy. Kidney Int. 1989;36(4):682–9.CrossRefPubMedGoogle Scholar
  52. 52.
    Kirchner KA, Martin CJ, Bower JD. Prostaglandin E2 but not I2 restores furosemide response in indomethacin-treated rats. Am J Phys. 1986;250(6 Pt 2):F980–5.Google Scholar
  53. 53.
    Knauf H, Mutschler E. Diuretic effectiveness of hydrochlorothiazide and furosemide alone and in combination in chronic renal failure. J Cardiovasc Pharmacol. 1995;26(3):394–400.CrossRefPubMedGoogle Scholar
  54. 54.
    Fliser D, Schroter M, Neubeck M, Ritz E. Coadministration of thiazides increases the efficacy of loop diuretics even in patients with advanced renal failure. Kidney Int. 1994;46(2):482–8.CrossRefPubMedGoogle Scholar
  55. 55.
    Elkayam U, Ng TM, Hatamizadeh P, Janmohamed M, Mehra A. Renal vasodilatory action of dopamine in patients with heart failure: magnitude of effect and site of action. Circulation. 2008;117(2):200–5.CrossRefPubMedGoogle Scholar
  56. 56.
    Bayram M, De Luca L, Massie MB, Gheorghiade M. Reassessment of dobutamine, dopamine, and milrinone in the management of acute heart failure syndromes. Am J Cardiol. 2005;96(6A):47G–58G.CrossRefPubMedGoogle Scholar
  57. 57.
    Gottlieb SS, Stebbins A, Voors AA, Hasselblad V, Ezekowitz JA, Califf RM, et al. Effects of nesiritide and predictors of urine output in acute decompensated heart failure: results from ASCEND-HF (acute study of clinical effectiveness of nesiritide and decompensated heart failure). J Am Coll Cardiol. 2013;62(13):1177–83.CrossRefPubMedGoogle Scholar
  58. 58.
    Valentin JP, Sechi LA, Qui C, Schambelan M, Humphreys MH. Urodilatin binds to and activates renal receptors for atrial natriuretic peptide. Hypertension. 1993;21(4):432–8.CrossRefPubMedGoogle Scholar
  59. 59.
    Singh A, Laribi S, Teerlink JR, Mebazaa A. Agents with vasodilator properties in acute heart failure. Eur Heart J. 2017;38(5):317–25.CrossRefPubMedGoogle Scholar
  60. 60.
    Paterna S, Di Pasquale P, Parrinello G, Fornaciari E, Di Gaudio F, Fasullo S, et al. Changes in brain natriuretic peptide levels and bioelectrical impedance measurements after treatment with high-dose furosemide and hypertonic saline solution versus high-dose furosemide alone in refractory congestive heart failure: a double-blind study. J Am Coll Cardiol. 2005;45(12):1997–2003.CrossRefPubMedGoogle Scholar
  61. 61.
    Licata G, Di Pasquale P, Parrinello G, Cardinale A, Scandurra A, Follone G, et al. Effects of high-dose furosemide and small-volume hypertonic saline solution infusion in comparison with a high dose of furosemide as bolus in refractory congestive heart failure: long-term effects. Am Heart J. 2003;145(3):459–66.CrossRefPubMedPubMedCentralGoogle Scholar
  62. 62.
    Paterna S, Fasullo S, Parrinello G, Cannizzaro S, Basile I, Vitrano G, et al. Short-term effects of hypertonic saline solution in acute heart failure and long-term effects of a moderate sodium restriction in patients with compensated heart failure with New York Heart Association class III (Class C) (SMAC-HF Study). Am J Med Sci. 2011;342(1):27–37.CrossRefPubMedPubMedCentralGoogle Scholar
  63. 63.
    Konstam MA, Gheorghiade M, Burnett JC Jr, Grinfeld L, Maggioni AP, Swedberg K, et al. Effects of oral tolvaptan in patients hospitalized for worsening heart failure: the EVEREST Outcome Trial. JAMA. 2007;297(12):1319–31.CrossRefPubMedGoogle Scholar
  64. 64.
    Gheorghiade M, Konstam MA, Burnett JC Jr, Grinfeld L, Maggioni AP, Swedberg K, et al. Short-term clinical effects of tolvaptan, an oral vasopressin antagonist, in patients hospitalized for heart failure: the EVEREST Clinical Status Trials. JAMA. 2007;297(12):1332–43.CrossRefPubMedGoogle Scholar
  65. 65.
    Merrill RH. The technique of slow continuous ultrafiltration. Steps to maintain fluid balance without hemodynamic instability. J Crit Illn. 1991;6(3):289–94.PubMedGoogle Scholar
  66. 66.
    Wei SS, Lee WT, Woo KT. Slow continuous ultrafiltration (SCUF)—the safe and efficient treatment for patients with cardiac failure and fluid overload. Singap Med J. 1995;36(3):276–7.Google Scholar
  67. 67.
    Bart BA, Goldsmith SR, Lee KL, Givertz MM, O’Connor CM, Bull DA, et al. Ultrafiltration in decompensated heart failure with cardiorenal syndrome. N Engl J Med. 2012;367(24):2296–304.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Nephrology, Department of Internal MedicineUniversity of Iowa Hospitals and ClinicsIowa CityUSA

Personalised recommendations