The 3rd Department of Cardiology, National and Kapodistrian University of Athens, 67 Mikras Asias Street, 11527 Athens, Greece.
Eur Heart J Cardiovasc Pharmacother. 2018 Jan 1;4(1):54-63. doi: 10.1093/ehjcvp/pvx020.
Loop diuretics are recommended for relieving symptoms and signs of congestion in patients with chronic heart failure and are administered to more than 80% of them. However, several of their effects have not systematically been studied. Numerous cohort and four interventional studies have addressed the effect of diuretics on renal function; apart from one prospective study, which showed that diuretics withdrawal is accompanied by increase in some markers of early-detected renal injury, all others converge to the conclusion that diuretics receipt, especially in high doses is associated with increased rates of renal dysfunction. Although a long standing perception has attributed a beneficial effect to diuretics in the setting of chronic heart failure, many cohort studies support that their use, especially in high doses is associated with adverse outcome. Several studies have used propensity scores in order to match diuretic and non-diuretic receiving patients; their results reinforce the notion that diuretics use and high diuretics dose are true risk factors and not disease severity markers, as some have suggested. One small, randomized study has demonstrated that diuretics decrease is feasible and safe and accompanied by a better prognosis. In conclusion, until elegantly designed, randomized trials, powered for clinical endpoints answer the unsettled issues in the field, the use of diuretics in chronic heart failure will remain subject to physicians' preferences and biases and not evidence based.
利尿剂被推荐用于缓解慢性心力衰竭患者的充血症状和体征，超过 80%的患者使用利尿剂。然而，它们的许多作用并没有系统地研究过。许多队列研究和四项干预性研究都探讨了利尿剂对肾功能的影响；除了一项前瞻性研究表明利尿剂停药后会增加一些早期发现的肾损伤标志物外，所有其他研究都得出结论，利尿剂的使用，尤其是高剂量，与肾功能障碍的发生率增加有关。尽管长期以来人们认为利尿剂在慢性心力衰竭中有益，但许多队列研究支持利尿剂的使用，尤其是高剂量与不良预后有关。一些研究使用倾向评分来匹配使用利尿剂和不使用利尿剂的患者；他们的结果进一步证实，利尿剂的使用和高剂量利尿剂是真正的风险因素，而不是一些人所认为的疾病严重程度的标志物。一项小型随机研究表明，减少利尿剂的使用是可行和安全的，并伴有更好的预后。总之，在该领域未解决的问题得到精心设计、针对临床终点的随机试验回答之前，利尿剂在慢性心力衰竭中的使用将仍然取决于医生的偏好和偏见，而不是基于证据。
