Key result
Optimizing diuretics with sequential nephron blockade, ARNIs, potassium binders, and SGLT2i improves HF survival and symptoms.
Why the study?
In clinical practice, fluid expansion in heart failure is often undiagnosed and diuretic therapy is not always adequately titrated, despite several available drug classes with diuretic properties.
How can diuretic therapy be optimized using currently available drugs to improve outcomes in patients with heart failure?
How can diuretic therapy be optimized using currently available drugs to improve outcomes in patients with heart failure?
Optimizing diuretic therapy through sequential nephron blockade and the integration of newer agents like ARNIs and SGLT2 inhibitors is essential for comprehensive heart failure management.
Should not yet alter HF diuretic strategies; leaves open need for RCTs confirming combined regimen benefits.
Considering the pathophysiology and clinical presentation of heart failure, using diuretics or drugs with diuretic properties is indispensable for adequate management of heart failure patients. However, in clinical practice, fluid expansion is often undiagnosed, and diuretic therapy is not always adequately titrated. Today, several drug classes with diuretic properties are available in addition to classical thiazides, thiazide-like, and loop diuretics. The purpose of this short review is to discuss different ways to optimize diuretic therapy using currently available drugs. Several approaches are considered, including a combination of diuretics to obtain a sequential nephron blockade, use of a drug combining a blocker of the renin-angiotensin system (RAS) and an inhibitor of the metabolism of natriuretic peptides (ARNI), prescription of potassium binders to maintain and up-titrate RAS blockers and mineralocorticoid antagonists, and finally use of inhibitors of renal reabsorption of glucose through the sodium-glucose cotransporter 2 system. Optimal use of these various drug classes should improve the quality of life and reduce the need for hospital admissions and mortality in heart failure patients.
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Burnier et al. (2023) conducted a review in Heart failure. Diuretic therapy optimization was evaluated. Optimizing diuretic therapy with sequential nephron blockade, ARNIs, potassium binders, and SGLT2 inhibitors should improve quality of life and reduce mortality in heart failure patients.
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