Heavy Use of Diuretics vs. Ultrafiltration in Cardiorenal Overload Syndrome: A Literature Review

Abstract

The Cardiorenal Syndrome (CRS) is a complex clinical entity that involves a bidirectional interaction between the heart and kidneys, with a high incidence among patients with cardiovascular and renal diseases. Volume overload is a central feature of CRS, and its optimal management poses a challenge for healthcare professionals. In this context, both the intensive use of diuretics and ultrafiltration have gained prominence as therapeutic strategies to address volume overload and alleviate systemic congestion in patients with CRS. Objective: This review aims to critically compare the efficacy, safety, and practical considerations of the intensive use of diuretics versus ultrafiltration in the management of volume overload in CRS. Methods: A comprehensive review of the literature was conducted, encompassing studies, clinical trials, and meta-analyses comparing the two therapeutic approaches in CRS. Results: The intensive use of diuretics, particularly loop diuretics, has been widely employed due to its rapid action and availability in various clinical settings. Diuretics effectively increase sodium and water excretion, resulting in reduced circulating volume and relief of pulmonary and peripheral congestion. On the other hand, ultrafiltration offers a more precise and controlled elimination of fluids, potentially benefitting patients sensitive to fluid and electrolyte imbalances. Ultrafiltration may be a viable option in patients with diuretic resistance or those at risk of electrolyte depletion. However, current evidence is limited and inconclusive regarding the superiority of one strategy over the other in terms of efficacy. Conclusion: The choice between the intensive use of diuretics and ultrafiltration should be based on individualized patient assessment, considering the severity of volume overload, renal function, diuretic tolerance, and comorbidities. Both therapeutic approaches have advantages and drawbacks, and a one-size-fits-all approach is not suitable for CRS management. Further large-scale, well-designed clinical trials are required to establish the optimal therapeutic approach in CRS. Multidisciplinary collaboration and personalized treatment based on evidence and clinical experience are crucial for optimizing clinical outcomes and improving the quality of life of patients with CRS and volume overload.