Diuretic Resistance in Heart Failure.
Diuretic Resistance in Heart Failure.
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DOI：
10.1007/s11897-019-0424-1
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发表时间：
2019-04-01
影响因子：
--
通讯作者：
Collins, Sean
中科院分区：
文献类型：
--
作者：
Gupta, Richa;Testani, Jeffrey;Collins, Sean
综述的目的：利尿剂抵抗（DR）发生在一个相对严重的频谱上，并有助于住院期间急性心力衰竭（AHF）的恶化。这篇综述综述了DR的机制，重点是循环利尿剂，并总结了目前关于AHF中利尿效率的预测价值和利钠反应的预测因素的文献。最近发现：利尿剂的药代动力学在慢性心力衰竭中受损，但对AHF中DR的机制知之甚少。几乎所有循环利尿剂剂量后的利尿都发生在给药后的最初几个小时内，剂量内可发生DR。最近的研究表明，在肾元水平的DR可能比利尿剂输送到小管的缺陷更重要。由于环状利尿剂可诱导尿钠，因此尿钠（UNa）浓度可作为对给定环状利尿剂剂量的利尿反应性的功能、生理和直接测量。识别并针对DR患者进行更积极、更有针对性的治疗是改善预后的重要机会。需要更好地了解AHF中DR的机制基础，以确定其他生物标志物并指导未来的试验和治疗。
PURPOSE OF REVIEW: Diuretic resistance (DR) occurs along a spectrum of relative severity and contributes to worsening of acute heart failure (AHF) during an inpatient stay. This review gives an overview of mechanisms of DR with a focus on loop diuretics and summarizes the current literature regarding the prognostic value of diuretic efficiency and predictors of natriuretic response in AHF.RECENT FINDINGS: The pharmacokinetics of diuretics are impaired in chronic heart failure, but little is known about mechanisms of DR in AHF. Almost all diuresis after administration of a loop diuretic dose occurs in the first few hours after administration and within-dose DR can develop. Recent studies suggest that DR at the level of the nephron may be more important than defects in diuretic delivery to the tubule. Because loop diuretics induce natriuresis, urine sodium (UNa) concentration may serve as a functional, physiological, and direct measure for diuretic responsiveness to a given loop diuretic dose. Identifying and targeting individuals with DR for more aggressive, tailored therapy represents an important opportunity to improve outcomes. A better understanding of the mechanistic underpinnings of DR in AHF is needed to identify additional biomarkers and guide future trials and therapies.