Diuretic resistance in acute heart failure is a common clinical problem, and it is associated with adverse outcomes. Effective therapies are still lacking. The Doraya catheter, a temporary intravenous flow regulator placed in the inferior vena cava below the level of the renal veins, is a novel device designed to target renal and cardiac congestion, thereby improving diuretic response. A first-in-man clinical study is currently ongoing.
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http://dx.doi.org/10.1016/j.cardfail.2019.08.017 | DOI Listing |
Am J Emerg Med
January 2025
Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, USA.
Introduction: Patients with heart failure exacerbation can present in a variety of ways, including sympathetic crashing acute pulmonary edema (SCAPE). Emergency physicians play a key role in the diagnosis and management of this condition.
Objective: This narrative review evaluates key evidence-based updates concerning the diagnosis and management of SCAPE for the emergency clinician.
J Clin Med
January 2025
Department of Nephrology, Dialysis and Internal Diseases, Medical University of Warsaw, 02-097 Warsaw, Poland.
Hypertension in chronic kidney disease patients is very common. The definition of resistant hypertension in the general population is as follows: uncontrolled blood pressure (BP) on three or more hypotensive agents in adequate doses, or when patients are on four or more hypotensive agent categories irrespective of the BP control, with diuretics included in the therapy. However, these resistant hypertension definitions do not apply to the setting of end-stage kidney disease.
View Article and Find Full Text PDFJ Hypertens
December 2024
University/British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, Scotland, UK.
Introduction: Hypertension is the leading preventable cause of cardiovascular morbidity and mortality globally, with a disproportionate impact on low-income and middle-income countries like Sri Lanka. Effective blood pressure (BP) control improves outcomes in patients with hypertension. This study aimed to assess the prevalence of uncontrolled hypertension, and its correlates among Sri Lankan patients with hypertension in clinic settings.
View Article and Find Full Text PDFJACC Heart Fail
January 2025
Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA; Baylor Scott and White Research Institute, Baylor Scott and White Health, Dallas, Texas, USA. Electronic address:
Several trials have evaluated diuretic-based strategies to improve symptoms and outcomes in patients with acute heart failure (AHF). The authors sought to summarize the effect of different combination strategies on symptoms, physical signs, physiological variables, and outcomes in patients with AHF. Twelve trials were identified that assessed the addition of thiazide diuretics, sodium-glucose cotransporter 2 inhibitors, mineralocorticoid receptor antagonists, vasopressin receptor antagonists, carbonic anhydrase inhibitors, or loop diuretic intensification to conventional therapy for AHF.
View Article and Find Full Text PDFNat Rev Nephrol
January 2025
AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Diuretic drugs act on electrolyte transporters in the kidney to induce diuresis and are often used in chronic kidney disease (CKD), given that nephron loss creates a deficit in the ability to excrete dietary sodium, which promotes an increase in plasma volume. This rise in plasma volume is exacerbated by CKD-induced systemic and intra-renal activation of the renin-angiotensin-aldosterone-system, which further limits urinary sodium excretion. In the absence of a compensatory decrease in systemic vascular resistance, increases in plasma volume induced by sodium retention can manifest as a rise in systemic arterial blood pressure.
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