Comparative Strategies to Overcome Diuretic Resistance in Heart Failure: A Network Meta-Analysis - PubMed
6 hours ago
- #diuretic resistance
- #heart failure
- #network meta-analysis
- Diuretic resistance complicates decongestion in heart failure (HF), with multiple add-on strategies used but uncertain comparative efficacy and safety.
- A network meta-analysis compared pharmacologic strategies for diuretic resistance in HF, analyzing 19 RCTs (n = 9,685).
- Tolvaptan and low-dose loop diuretics plus tolvaptan significantly increased 72-hour urine output.
- Hydrochlorothiazide and tolvaptan showed the greatest standardized reductions in 72-hour weight change.
- Dapagliflozin and empagliflozin reduced heart failure hospitalizations.
- High-dose loop diuretics and hydrochlorothiazide were associated with increased acute kidney injury (AKI).
- Sodium-glucose cotransporter 2 inhibitors may lower rehospitalization with a favorable renal profile, while nephron-segment add-ons enhance short-term decongestion but require AKI/electrolyte monitoring.