Proximal versus distal diuretics in congestive heart failure.

IF 4.8 2区 医学 Q1 TRANSPLANTATION
Massimo Nardone, Vikas S Sridhar, Kevin Yau, Ayodele Odutayo, David Z I Cherney
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引用次数: 0

Abstract

Volume overload represents a hallmark clinical feature linked to the development and progression of heart failure (HF). Alleviating signs and symptoms of volume overload represents a foundational HF treatment target that is achieved using loop diuretics in the acute and chronic setting. Recent work has provided evidence to support guideline-directed medical therapies, such as sodium glucose cotransporter 2 (SGLT2) inhibitors and mineralocorticoid receptor (MR) antagonists, as important adjunct diuretics that may act synergistically when used with background loop diuretics in people with chronic HF. Furthermore, there is growing interest in understanding the role of SGLT2 inhibitors, carbonic anhydrase inhibitors, thiazide diuretics, and MR antagonists in treating volume overload in patients hospitalized for acute HF, particularly in the setting of loop diuretic resistance. Thus, the current review demonstrates that: (i) SGLT2 inhibitors and MR antagonists confer long-term cardioprotection in chronic HF patients but it is unclear whether natriuresis or diuresis represents the primary mechanisms for this benefit, (ii) SGLT2 inhibitors, carbonic anhydrase inhibitors, and thiazide diuretics increase natriuresis in the acute HF setting, but implications on long-term outcomes remain unclear and warrants further investigation, and (iii) a multi-nephron segment approach, using agents that act on distinct segments of the nephron, potentiate diuresis to alleviate signs and symptoms of volume overload in acute HF.

充血性心力衰竭患者使用近端利尿剂还是远端利尿剂?
容量超负荷是心力衰竭(HF)发生和发展的标志性临床特征。缓解容量负荷过重的体征和症状是心力衰竭治疗的基本目标,在急性和慢性期均使用襻利尿剂。最近的工作提供了证据支持指导性医疗疗法,如钠葡萄糖共转运体 2 (SGLT2) 抑制剂和矿物质皮质激素受体 (MR) 拮抗剂,它们是重要的辅助性利尿剂,在慢性心力衰竭患者中与襻利尿剂一起使用时可发挥协同作用。此外,越来越多的人希望了解 SGLT2 抑制剂、碳酸酐酶抑制剂、噻嗪类利尿剂和 MR 拮抗剂在治疗急性心房颤动住院患者容量超负荷方面的作用,尤其是在襻利尿剂耐药的情况下。因此,本综述证明1)SGLT2 抑制剂和磁共振拮抗剂可为慢性心房颤动患者提供长期的心脏保护,但目前尚不清楚这种益处的主要机制是利尿还是利尿,2)SGLT2 抑制剂、碳酸酐酶抑制剂和噻嗪类利尿剂可增加急性心房颤动患者的利尿、3)使用作用于肾小球不同区段的药物的多肾小球区段方法可增强利尿作用,从而减轻急性心房颤动患者容量超负荷的体征和症状。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Nephrology Dialysis Transplantation
Nephrology Dialysis Transplantation 医学-泌尿学与肾脏学
CiteScore
10.10
自引率
4.90%
发文量
1431
审稿时长
1.7 months
期刊介绍: Nephrology Dialysis Transplantation (ndt) is the leading nephrology journal in Europe and renowned worldwide, devoted to original clinical and laboratory research in nephrology, dialysis and transplantation. ndt is an official journal of the [ERA-EDTA](http://www.era-edta.org/) (European Renal Association-European Dialysis and Transplant Association). Published monthly, the journal provides an essential resource for researchers and clinicians throughout the world. All research articles in this journal have undergone peer review. Print ISSN: 0931-0509.
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