Mechanisms and management of diuretic resistance

Abstract

Increased incidence of diuretic resistance may be caused by: patient noncompliance, incorrect diagnosis, pharmacokinetic and pharmacodynamic properties of the diuretic, renal and extrarenal disease. The mechanisms of diuretic resistance can be determined by changes in pharmacokinetics and pharmacodynamics of the drugs; pathological disorders in cardiovascular, renal, hepatic diseases, by and drug interactions. Diuretic resistance can be overcome by basic measures (reducing sodium intake; suspending the drugs that reduce the efficiency of diuretics; establishing effective dosage; increasing dosage of diuretics; adjusting diuretic administration regimen; substituting or using an alternative loop diuretic; intravenous administration of diuretic; continuous infusion of diuretic; combined therapy with other classes of diuretics) and alternatives (use of hypertonic saline solutions; use of positive inotropic drugs; management of intra-abdominal pressure; albumin infusion; administration of type 2 receptor antagonists of vasopressin, glucocorticoids, calcium sensitizers, vasodilators; use of ultrafiltration).