The Addition of Metolazone to the Management of Heart Failure Improves Renal Function in Patients With Severe Signs of Volume Overload

Abstract

Loop diuretics are commonly used to treat volume overload in heart failure (HF). Some patients continue to experience fluid overload despite being exposed to high doses of loop diuretics. Combination therapy using metolazone with loop diuretics is commonly practiced in these cases. Available data on this practice comes from small studies totaling less than 300 HF patients, which in most cases show an improvement in diuresis but worsening renal function. The cardio renal syndromes are defined as disorders of the heart and kidneys whereby acute or chronic dysfunction in one organ may induce dysfunction of the other. Venous congestion in the renal vasculature is one of the contributing mechanisms implicated in the effect of HF on AKI. Systemic venous congestion is a predominant symptom of right sided HF. In this study, we hypothesized that adding metolazone to loop diuretics in patients with severe refractory predominantly right sided HF will not only improve symptoms of volume overload but will also improve renal function by relieving the effect of venous congestion in the renal vasculature.