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[The use of diuretics in heart insufficiency in the elderly]
1Faculdade de Ciências Médicas (UNL), Hospital Pulido Valente, Lisboa.
Insights
This review examines diuretic use in elderly patients with congestive heart failure, focusing on kidney function, adverse effects, and safe prescribing practices for this vulnerable population.
Area of Science:
- Geriatric Medicine
- Pharmacology
- Nephrology
Context:
- Aging impacts kidney function and drug metabolism, increasing risks for elderly patients.
- Congestive heart failure exacerbates renal changes and complicates diuretic therapy in older adults.
- Elderly individuals exhibit unique pharmacodynamic and pharmacokinetic responses to diuretics.
Purpose:
- To review the use of diuretics in elderly patients with congestive heart failure.
- To analyze age-related kidney function alterations and their impact on diuretic pharmacokinetics and pharmacodynamics.
- To provide recommendations for safe and effective diuretic prescribing in the elderly.
Summary:
- The review covers age-related kidney function changes, diuretic pharmacokinetics/pharmacodynamics in older adults with congestive heart failure, and the role of low-sodium diets.
- It details reasons for elderly susceptibility to diuretics, selection criteria, common adverse effects (e.g., hypokalemia), and contraindications.
- Hemodynamic risks of excessive diuresis and strategies for preventing/correcting hypokalemia are discussed, concluding with practical recommendations.
Impact:
- Informs healthcare providers on optimizing diuretic therapy for elderly patients with heart failure.
- Aims to reduce adverse events and improve therapeutic outcomes in this population.
- Highlights the importance of individualized treatment plans considering age-related physiological changes.
Abstract:
The kidney function alterations with age and on congestive heart failure, are reviewed as the pharmacocynetic and pharmacodynamic of the diuretics on old patients with this syndrome. The therapeutic importance of hiposodic diet was considered. The reasons for the susceptibility of old people to diuretics and the criteria for the choice of the diuretic on this age, are reviewed. So are the most important adverse effect of diuretics on old people and the contra-indication for the use of these drugs on elderly. The importance of hypocalaemia on old people and how to prevent or correct it are considered. The haemodynamic risks of an excessive diureses are reviewed. Finally, we propose some recommendations about the use of diuretics on the elderly.