Diuretic therapy in heart failure: Current controversies and new approaches for fluid removal

Filippo Brandimarte*, Gian Francesco Mureddu, Alessandro Boccanelli, Giuseppe Cacciatore, Camillo Brandimarte, Francesco Fedele, Mihai Gheorghiade

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

16 Scopus citations


Hospitalization for heart failure is a major health problem with high in-hospital and postdischarge mortality and morbidity. Non-potassium-sparing diuretics (NPSDs) still remain the cornerstone of therapy for fluid management in heart failure despite the lack of large randomized trials evaluating their safety and optimal dosing regimens in both the acute and chronic setting. Recent retrospective data suggest increased mortality and re-hospitalization rates in a wide spectrum of heart failure patients receiving NPSDs, particularly at high doses. Electrolyte abnormalities, hypotension, activation of neurohormones, and worsening renal function may all be responsible for the observed poor outcomes. Although NPSD will continue to be important agents to promptly resolve signs and symptoms of heart failure, alternative therapies such as vasopressine antagonists and adenosine blocking agents or techniques like veno-venous ultrafiltration have been developed in an effort to reduce NPSD exposure and minimize their side effects. Until other new agents become available, it is probably prudent to combine NPSD with aldosterone blocking agents that are known to improve outcomes.

Original languageEnglish (US)
Pages (from-to)563-570
Number of pages8
JournalJournal of Cardiovascular Medicine
Issue number8
StatePublished - Aug 2010


  • adenosine antagonists
  • cardiorenal syndrome
  • congestion
  • heart failure
  • loop diuretic
  • mortality
  • renal dysfunction
  • ultrafiltration
  • vasopressin antagonists

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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