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• W2897057064 abstract "The leading cause of death worldwide is cardiovascular disease. The heart and the kidneys are functionally interdependent, such that dysfunction in one organ may cause dysfunction in the other. By one estimate, more than 60% of patients with congestive heart failure develop chronic kidney disease. Volume overload and congestion are hallmarks of heart failure, and these findings are associated with severe symptoms and poor outcomes. Given the importance of congestion, diuretics remain a cornerstone of heart failure management. However, diuretic treatment remains largely empirical, with little evidence currently available to guide decisions. In this review, we discuss the pathophysiology of cardiorenal syndrome, the pharmacology of loop diuretics, mechanisms of diuretic resistance, and evidence-based treatment paradigms. The leading cause of death worldwide is cardiovascular disease. The heart and the kidneys are functionally interdependent, such that dysfunction in one organ may cause dysfunction in the other. By one estimate, more than 60% of patients with congestive heart failure develop chronic kidney disease. Volume overload and congestion are hallmarks of heart failure, and these findings are associated with severe symptoms and poor outcomes. Given the importance of congestion, diuretics remain a cornerstone of heart failure management. However, diuretic treatment remains largely empirical, with little evidence currently available to guide decisions. In this review, we discuss the pathophysiology of cardiorenal syndrome, the pharmacology of loop diuretics, mechanisms of diuretic resistance, and evidence-based treatment paradigms. Clinical Summary•Cardiorenal syndrome (CRS) is caused by several pathophysiological mechanisms, notably congestion of the renal venous vasculature.•Loop diuretics are the cornerstone of treatment of CRS for effecting natriuresis, net negative salt and water balance, and extracellular volume reduction.•Preventing and managing diuretic resistance in CRS requires a multidisciplinary approach that entails restricting dietary salt intake, optimizing dose and frequency of loop diuretic administration, recognizing nephron remodeling and the braking phenomenon, and adding additional classes of diuretics. •Cardiorenal syndrome (CRS) is caused by several pathophysiological mechanisms, notably congestion of the renal venous vasculature.•Loop diuretics are the cornerstone of treatment of CRS for effecting natriuresis, net negative salt and water balance, and extracellular volume reduction.•Preventing and managing diuretic resistance in CRS requires a multidisciplinary approach that entails restricting dietary salt intake, optimizing dose and frequency of loop diuretic administration, recognizing nephron remodeling and the braking phenomenon, and adding additional classes of diuretics." @default.
• W2897057064 created "2018-10-26" @default.
• W2897057064 creator A5071969297 @default.
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• W2897057064 date "2018-09-01" @default.
• W2897057064 modified "2023-10-10" @default.
• W2897057064 title "Diuretics in the Management of Cardiorenal Syndrome" @default.
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• W2897057064 doi "https://doi.org/10.1053/j.ackd.2018.08.008" @default.
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