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Toward quantification of loop diuretic responsiveness for congestive heart failure
1Clinical Sciences and Advanced Medicine, University of Pennsylvania, MJR-VHUP-Cardiology, Philadelphia, Pennsylvania, USA.
Journal of Veterinary Internal Medicine
|November 21, 2022
Summary
Quantifying diuretic response in dogs with congestive heart failure (CHF) using urine sodium (uNa) and natriuresis offers improved treatment insights. This approach moves beyond clinical signs to better manage diuretic resistance and enhance patient outcomes.
Area of Science:
- Veterinary Medicine
- Cardiology
- Pharmacology
Background:
- Congestive heart failure (CHF) in dogs is commonly treated with diuretics like furosemide.
- Current treatment efficacy relies on clinical signs, not quantitative measures of diuretic action.
- Human medicine increasingly uses urine sodium (uNa) and volume to guide diuretic therapy, improving outcomes.
Approach:
- This review focuses on the role of sodium (Na) and natriuresis in loop diuretic action for CHF.
- It proposes definitions for diuretic responsiveness and resistance in veterinary patients.
- The review examines the impact of interstitial Na on body water homeostasis and congestion.
Key Points:
- Loop diuretics function via natriuresis; monitoring uNa provides deeper insights into CHF pathophysiology and diuretic pharmacology.
- Quantitative measures of diuretic responsiveness correlate with reduced hospitalization, complications, rehospitalization, and mortality in humans.
- Understanding diuretic resistance is crucial for tailoring personalized interventions and avoiding difficult decongestion.
Conclusions:
- A quantitative approach to diuretic use in dogs with CHF, emphasizing natriuresis, will enhance understanding and care.
- Defining and measuring diuretic responsiveness and resistance is essential for optimizing treatment strategies.
- Further research is needed to address current knowledge gaps in veterinary diuretic therapy.
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