Hospital Universitari i Politecnic La Fe, IIS La Fe, Valencia, Spain.
Centro de Investigación Biomedica en Red (CIBERCV)-Madrid, Spain.
Curr Pharm Des. 2023;29(20):1592-1601. doi: 10.2174/1381612829666230714153404.
Heart failure is a major problem in developed countries, leading to a high number of hospitalizations and healthcare costs. The most common symptom of heart failure is congestion, which is also the primary reason for hospitalization. Diuretics, particularly loop diuretics, are the cornerstone of the treatment of congestion. Likewise, there are other types of diuretics with different pathways of action, bioavailability profiles, adverse reactions, and effects on the cardiovascular and renal systems. Moreover, in recent years, new therapeutic alternatives have been proposed for challenging cases of diuretic resistance, such as ultrafiltration through peripheral access or peritoneal dialysis. The main objective of this article is to provide a step-guided approach to the management of congestion in patients with heart failure in order to guide the medical practice. Despite the significant amount of research published in recent years, there are no clear algorithms for managing acute heart failure. Diuretics remain the primary treatment of acute heart failure, and nephron blockade is key, but new therapies are emerging, and ongoing research is needed to develop better strategies for managing this condition.
心力衰竭是发达国家的一个主要问题，导致大量住院和医疗保健费用。心力衰竭最常见的症状是充血，这也是住院的主要原因。利尿剂，特别是袢利尿剂，是治疗充血的基石。同样，还有其他类型的利尿剂，具有不同的作用途径、生物利用度谱、不良反应以及对心血管和肾脏系统的影响。此外，近年来，针对利尿剂抵抗的挑战性病例，已经提出了一些新的治疗替代方案，例如通过外周通路或腹膜透析进行超滤。本文的主要目的是为心力衰竭患者的充血管理提供一个分步指导方法，以指导医疗实践。尽管近年来发表了大量研究，但在管理急性心力衰竭方面尚无明确的算法。利尿剂仍然是急性心力衰竭的主要治疗方法，肾单位阻断是关键，但新的治疗方法正在出现，需要进行进一步的研究，以制定更好的策略来管理这种情况。
