Glucocorticoids in Diuretic Resistance: An Emerging Approach for Heart Failure

Diuretic resistance creates a significant challenge in the management of patients with heart failure (HF), contributing to recurrent hospitalizations and poor outcomes. The American Heart Association projects that by 2030, HF will affect more than 8 million adults in the United States. Factors such as pharmacokinetic alterations, hormonal dysregulation, and cardiorenal syndrome (CRS) contribute to the development of diuretic resistance. Although not part of standard care, glucocorticoids (eg, dexamethasone and prednisone) have been investigated for their potential systemic and cardiovascular effects reflected in the stimulation of a diuretic effect and improvement of renal function. This narrative review explores the definition of diuretic resistance, its pathogenesis, clinical implications, and the potential role of glucocorticoids as an adjunctive therapy, highlighting the need for further research to establish their efficacy and safety.