Diuretic Resistance and Chronic Heart Failure

Diuretic resistance is a predictor of adverse outcome in acute and chronic heart failure. Failure of loop diuretic treatment to maintain euvolemia can precipitate acute decompensation of heart failure and hospitalization or emergency treatment. Diuretic resistance can develop because of multiple mechanisms leading to progressive volume overload and congestion. A timely detection of loop diuretic resistance is key to promptly adopt treatment strategies in order to restore an optimal fluid balance. Increased diuretic doses, changing route of administration from oral to intravenous, combined diuretic treatment are possible strategies that can be put in place to deal with diuretic resistance in patients with heart failure. In this chapter early detection of congestion and treatment of loop diuretic resistance are discussed.