que se leu este artigo
array:23 [ "pii" => "S0870255123001646" "issn" => "08702551" "doi" => "10.1016/j.repc.2022.05.012" "estado" => "S300" "fechaPublicacion" => "2023-09-01" "aid" => "2160" "copyright" => "Sociedade Portuguesa de Cardiologia" "copyrightAnyo" => "2023" "documento" => "article" "crossmark" => 1 "subdocumento" => "rev" "cita" => "Rev Port Cardiol. 2023;42:797-803" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:18 [ "pii" => "S0870255123001865" "issn" => "08702551" "doi" => "10.1016/j.repc.2019.12.013" "estado" => "S300" "fechaPublicacion" => "2023-09-01" "aid" => "2183" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Rev Port Cardiol. 2023;42:805-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Glossopharyngeal neuralgia with cardioinhibitory syncope: Is a permanent pacemaker required?" 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electrocardiogram – continuous monitoring electrocardiogram during syncope episode related with cervical unilateral pain showing an asystole period.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Ana Marques, Daniel Caldeira, Sofia Alegria, Ana Rita Pereira, Isabel João, Hélder Pereira" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Ana" "apellidos" => "Marques" ] 1 => array:2 [ "nombre" => "Daniel" "apellidos" => "Caldeira" ] 2 => array:2 [ "nombre" => "Sofia" "apellidos" => "Alegria" ] 3 => array:2 [ "nombre" => "Ana Rita" "apellidos" => "Pereira" ] 4 => array:2 [ "nombre" => "Isabel" "apellidos" => "João" ] 5 => array:2 [ "nombre" => "Hélder" "apellidos" => "Pereira" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255123001865?idApp=UINPBA00004E" "url" => "/08702551/0000004200000009/v1_202309041131/S0870255123001865/v1_202309041131/en/main.assets" ] "itemAnterior" => array:17 [ "pii" => "S0870255123002792" "issn" => "08702551" "doi" => "10.1016/j.repc.2023.05.007" "estado" => "S300" "fechaPublicacion" => "2023-09-01" "aid" => "2212" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "dis" "cita" => "Rev Port Cardiol. 2023;42:795-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial comment</span>" "titulo" => "Predictive value of a positive stress single-photon emission computed tomography or stress cardiac magnetic resonance for ruling in obstructive coronary artery disease in a real-world setting" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "795" "paginaFinal" => "796" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Valor preditivo da cintigrafia de perfusão miocárdica ou da ressonância magnética cardíaca na avaliação da doença arterial coronária obstrutiva num cenário da vida real" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Pedro Matos" "autores" => array:1 [ 0 => array:2 [ "nombre" => "Pedro" "apellidos" => "Matos" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255123002792?idApp=UINPBA00004E" "url" => "/08702551/0000004200000009/v1_202309041131/S0870255123002792/v1_202309041131/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">State of the Art</span>" "titulo" => "Diuretic-resistant heart failure and the role of ultrafiltration: A proposed protocol" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "797" "paginaFinal" => "803" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Francisca Gomes da Silva, Rita Calça, Ana Rita Martins, Inês Araújo, Carlos Aguiar, Cândida Fonseca, Patrícia Branco" "autores" => array:7 [ 0 => array:4 [ "nombre" => "Francisca" "apellidos" => "Gomes da Silva" "email" => array:1 [ 0 => "asilva19@campus.ul.pt" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Rita" "apellidos" => "Calça" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Ana" "apellidos" => "Rita Martins" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Inês" "apellidos" => "Araújo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 4 => array:3 [ "nombre" => "Carlos" "apellidos" => "Aguiar" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 5 => array:3 [ "nombre" => "Cândida" "apellidos" => "Fonseca" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 6 => array:3 [ "nombre" => "Patrícia" "apellidos" => "Branco" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Serviço de Nefrologia, Hospital Dr. Nélio Mendonça, Funchal, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Serviço de Nefrologia, Hospital de Santa Cruz, Carnaxide, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Serviço de Medicina Interna, Hospital de São Francisco Xavier, Lisboa, Portugal" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Serviço de Cardiologia, Hospital de Santa Cruz, Lisboa, Portugal" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Insuficiência cardíaca com resistência a diuréticos e o papel da ultrafiltração: protocolo de atuação" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3544 "Ancho" => 2508 "Tamanyo" => 552779 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Proposed protocol to treat diuretic resistant heart failure. NaCl: sodium chloride; SGLT2: sodium/glucose cotransporter 2; UNa+: urinary sodium; UO: urinary output.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Heart failure (HF) is a prevalent condition worldwide with high health care costs due to its disabling clinical behavior and associated recurrent hospital admissions, especially in the elderly.<a class="elsevierStyleCrossRefs" href="#bib0340"><span class="elsevierStyleSup">1,2</span></a> Acute HF decompensation generally manifests with signs and symptoms of congestion that strongly predict poor patient outcome.<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">3,4</span></a> Overall, the kidneys, being the major effectors of compensatory activity, play a central role in HF-related congestion and consequently management of HF symptoms.<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">5</span></a> Despite the lack of evidence of a mortality benefit in HF,<a class="elsevierStyleCrossRefs" href="#bib0365"><span class="elsevierStyleSup">6–8</span></a> efficacious diuretic therapy has been shown to prolong event-free survival and to relieve symptoms of congestion.<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">9</span></a> Loop diuretics are the cornerstone of this therapy and are widely used for acute management and chronic stabilization of HF.<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">10</span></a> However, a common problem is a diminished response to loop diuretics, affecting the patient's clinical course and potentially prolonging hospitalization. The term diuretic resistance (DR) is still not clearly defined,<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">11</span></a> but is generally taken to mean failure to decongest despite appropriate and escalating loop diuretic therapy.<a class="elsevierStyleCrossRefs" href="#bib0385"><span class="elsevierStyleSup">10–12</span></a> A poor diuretic response may be measured in different ways, depending on the study.<a class="elsevierStyleCrossRefs" href="#bib0400"><span class="elsevierStyleSup">13–15</span></a> In this analysis, we define an insufficient diuretic response in cases of congestion with volume overload as a spot urine sodium content <50–70 mEq/l after 2 h, and/or an hourly urine output <100–150 ml during the first 6 h after the administration of the drug.<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">16</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Risk factors for DR are better established and include a fractional excretion of sodium at baseline of less than 0.2%,<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">17</span></a> chloride levels at baseline between 97 and 103 mEq/l,<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">18</span></a> diabetes, low systemic blood pressure, elevated blood urea nitrogen and HF of ischemic origin.<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">10</span></a> Physiologic alterations in acute HF can alter loop diuretic pharmacokinetics and lead to DR, such as decreased gastric emptying, reduced splanchnic blood flow, intestinal wall edema<a class="elsevierStyleCrossRefs" href="#bib0430"><span class="elsevierStyleSup">19,20</span></a> and impaired delivery or reduced active secretion of loop diuretics by the organic acid transporter into the proximal tubule, as a consequence of HF-related decreased glomerular filtration.<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">21</span></a> However, an increase in dose or alteration in administration route should overcome this resistance if pharmacokinetic alterations were solely responsible for DR. A combination of pharmacokinetic and pharmacodynamic changes affecting the time course of diuretic delivery may explain the lack of therapeutic response.<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">22</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Management of diuretic resistance</span><p id="par0015" class="elsevierStylePara elsevierViewall">As long as the concentration of a loop diuretic in tubular fluid is sufficiently high to block the Na<span class="elsevierStyleSup">+</span>/K<span class="elsevierStyleSup">+</span>/2Cl<span class="elsevierStyleSup">−</span> cotransporter, there is a natriuretic response that activates the renin-angiotensin-aldosterone system (RAAS), leading to increased sodium absorption along the distal nephron. As soon as diuretic concentration falls below the diuretic threshold, these compensatory mechanisms trigger post-diuretic sodium retention. This involves all tubular segments and is enhanced when drug-free intervals are longer than four half-lives of the loop diuretic. If sodium intake is high, a negative sodium balance may not be achieved because post-diuretic salt retention can completely abolish the effect of the diuretic.<a class="elsevierStyleCrossRefs" href="#bib0450"><span class="elsevierStyleSup">23–25</span></a> After a chronic period of loop diuretic administration, enhanced sodium delivery to the distal tubular system results in compensatory hyperplasia and hypertrophy. Consequently, after multiple same-dose administration of diuretics, diuresis volume decreases, which is called the braking phenomenon.<a class="elsevierStyleCrossRefs" href="#bib0385"><span class="elsevierStyleSup">10,26</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">DR for any reason becomes a challenging problem in the hospital management of acute HF decompensation for patients treated with oral medication but with progressively worsening congestive symptoms. The initial approach to acute decompensated HF with DR should include an assessment of causes of pseudo-diuretic resistance, such as third-space overload with intravascular volume depletion (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>).<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">10</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">It is important to ensure that sodium intake is less than 100 mEq/day in order to mitigate the effects of post-diuretic sodium retention and to achieve a negative sodium balance.<a class="elsevierStyleCrossRef" href="#bib0470"><span class="elsevierStyleSup">27</span></a> The complete list of the patient's medications should also be reviewed, to ensure adherence and to identify drugs that exacerbate volume retention, such as nonsteroidal anti-inflammatory agents, and discontinue or replace them with safer alternatives.<a class="elsevierStyleCrossRef" href="#bib0475"><span class="elsevierStyleSup">28</span></a> If DR persists, adjustments to loop diuretic therapy may be considered. It is often necessary to increase the dose of a loop diuretic: 250–4000 mg/day, given orally, has been shown to relieve symptoms and reduce weight with no significant side effects.<a class="elsevierStyleCrossRef" href="#bib0480"><span class="elsevierStyleSup">29</span></a> Furthermore, more frequent administration of the diuretic can overcome the effects of post-diuretic salt retention by reducing the drug-free interval, and hence restore diuretic response.<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">30</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In the context of the SARS-CoV-2 pandemic, there have recently been efforts to reduce HF hospital management and its costs. Continuous subcutaneous furosemide administration by elastomeric pump enables congestion to be treated on an outpatient basis.<a class="elsevierStyleCrossRefs" href="#bib0490"><span class="elsevierStyleSup">31,32</span></a> This approach can be beneficial for all patients whose symptoms are uncontrolled, who do not respond to oral therapy, and/or who are not indicated for hospitalization. The acute strategy of our protocol is more often initiated at a heart failure day hospital but can also be used for hospital admissions, especially for elderly and frail patients in whom vascular access is more difficult and painful. Respiratory failure is the criterion for compulsorily hospitalizing the patient.<a class="elsevierStyleCrossRef" href="#bib0500"><span class="elsevierStyleSup">33</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Another method to overcome DR is sequential nephron blockade. Adding alternative classes of diuretics provides synergistic effects by avoiding rebound sodium retention. Acetazolamide inhibits proximal sodium reabsorption causing increased sodium concentrations in the loop of Henle, in which loop diuretics exert their natriuretic action. However, only short-term use is suggested due to the risk of metabolic acidosis. Another approach is to block sodium reabsorption at the distal tubule by adding a thiazide or thiazide-like diuretic. Distal tubule diuretics also prevent the adaptive process of cell hypertrophy that occurs with long-term loop diuretic use.<a class="elsevierStyleCrossRefs" href="#bib0505"><span class="elsevierStyleSup">34,35</span></a> The two most commonly used thiazides are metolazone and hydrochlorothiazide. Metolazone may be favored over other thiazide-type diuretics because of its additional effect on the proximal tubule, high oral bioavailability and low cost.<a class="elsevierStyleCrossRef" href="#bib0515"><span class="elsevierStyleSup">36</span></a> However, there is no clear evidence of superiority in terms of increasing diuresis, maintenance of renal function or avoiding electrolyte abnormalities.<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">10</span></a> Some authors recommend administering thiazides before loop diuretics to allow time for full blockade of the distal nephron.<a class="elsevierStyleCrossRef" href="#bib0470"><span class="elsevierStyleSup">27</span></a> As thiazide-type diuretics limit the kidneys’ capacity to dilute urine, they reduce free water clearance and should therefore be avoided in hypotonic hyponatremia. Other side effects are hypokalemia, dehydration, and renal failure.<a class="elsevierStyleCrossRef" href="#bib0520"><span class="elsevierStyleSup">37</span></a> Most patients with HF are already on a low dose of a mineralocorticoid receptor antagonist because of these drugs’ beneficial effect on mortality and HF hospitalizations. They are recommended in all cases of acute decompensated HF and reduced ejection fraction and should be added to treatment in naïve patients.<a class="elsevierStyleCrossRef" href="#bib0525"><span class="elsevierStyleSup">38</span></a> It is not clear whether there is a synergistic diuretic effect between mineralocorticoid receptor antagonists and loop diuretics.<a class="elsevierStyleCrossRefs" href="#bib0530"><span class="elsevierStyleSup">39,40</span></a> Besides minimizing potassium wasting by loop diuretics, spironolactone, eplerenone and finerenone have a mild but effective natriuretic effect. The rationale for using these drugs may not actually be sequential nephron blockade, but there is evidence for long-term benefit with increased dosages if glomerular filtration rate is stable and in the absence of hyperkalemia.<a class="elsevierStyleCrossRefs" href="#bib0365"><span class="elsevierStyleSup">6,37</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Tolvaptan inhibits vasopressin by binding to vasopressin receptors, preventing AQP2 recruitment and thereby leading to free-water excretion.<a class="elsevierStyleCrossRef" href="#bib0540"><span class="elsevierStyleSup">41</span></a> It results in short-term weight loss and dyspnea improvement in worsening HF, and can be a good adjunctive therapy in patients with DR.<a class="elsevierStyleCrossRef" href="#bib0545"><span class="elsevierStyleSup">42</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">For hospitalized patients, switching to intravenous (IV) loop diuretics is a way to avoid variable oral absorption and for symptomatic relief.<a class="elsevierStyleCrossRef" href="#bib0550"><span class="elsevierStyleSup">43</span></a> An intravenous dose between 400 and 600 mg of furosemide is generally considered the maximum total daily dose recommended, above which limited additional natriuresis should be expected but side effects will continue to increase.<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">16</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Whether to select intermittent bolus or continuous IV administration as an initial strategy remains controversial. Some studies conclude that IV boluses and continuous infusion have similar effectiveness and safety profiles,<a class="elsevierStyleCrossRef" href="#bib0555"><span class="elsevierStyleSup">44</span></a> while others claim that there are potential advantages to continuous infusion administration as this eliminates post-diuretic sodium retention and permits higher daily doses.<a class="elsevierStyleCrossRefs" href="#bib0490"><span class="elsevierStyleSup">31,32</span></a> We suggest a bolus of 80 mg or higher of IV furosemide in patients with reduced glomerular filtration rate. Patients on an outpatient diuretic regimen should receive at least the pre-existing oral dose administered intravenously. The DOSE-AHF trial demonstrated that high loop diuretic dose (2.5 times the usual home dose, with at least 80 mg/day of furosemide) compared to low dose (equal to home dose) resulted in a favorable effect on the secondary endpoints of dyspnea relief, change in weight and net fluid loss.<a class="elsevierStyleCrossRef" href="#bib0555"><span class="elsevierStyleSup">44</span></a> Hypertonic saline solution administered in conjunction with furosemide improves diuretic and sodium excretion rate. Some studies have also shown an all-cause mortality benefit, hypothesized to be due to decreased activation of adrenergic and renin-angiotensin systems by sodium overload and a consequent decrease in their detrimental effects on the cardiovascular system, improving outcome beyond the associated diuresis. This therapy is especially indicated for patients with hyponatremia as it causes a significant rise in serum sodium.<a class="elsevierStyleCrossRef" href="#bib0560"><span class="elsevierStyleSup">45</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Albumin infusion in addition to parenteral loop diuretics in hypoalbuminemic patients with acute HF showed improved diuresis and return to dry weight. The pathophysiologic mechanism remains unclear, but benefits are usually attributed to an increase in plasma oncotic pressure and increased diuretic delivery to the nephron.<a class="elsevierStyleCrossRef" href="#bib0565"><span class="elsevierStyleSup">46</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Extracorporeal ultrafiltration (ECUF) is also an option. This technique is highly effective at removing plasma fluid from blood across a semipermeable membrane through a hydrostatic pressure gradient. ECUF has been hypothesized to possess several advantages over diuretic therapy, including greater weight loss and fluid removal without affecting renal function, and lower mortality and rehospitalization, but without consistent results.<a class="elsevierStyleCrossRefs" href="#bib0570"><span class="elsevierStyleSup">47–52</span></a> Although ECUF is an excellent technique for volume control in diuretic resistant patients, it is an acute therapy for symptomatic relief and hemodynamic stabilization, in the absence of end-stage renal disease. For long-term control of hypervolemia, its efficacy and safety are not well established, and in addition it is a hospital-based therapy, which leads to a significant decrease in patients’ quality of life.<a class="elsevierStyleCrossRefs" href="#bib0385"><span class="elsevierStyleSup">10,11</span></a> The main goal in HF refractory to diuretics is to control volume on an outpatient basis, without decompensation or hospitalizations.</p><p id="par0065" class="elsevierStylePara elsevierViewall">While ECUF is a hospital-based solution, peritoneal dialysis (PD) is a home-based intermittent therapeutic option. PD is usually prescribed as a renal replacement therapy in end-stage kidney disease, but it can be customized to varying patient clinical needs. The rationale for using PD as a method of fluid removal in congestive HF is manifold. It also allows effective solute clearance, which leads to better uptitration of HF drugs such as RAAS blockers, and to enhanced diuretic responsiveness.<a class="elsevierStyleCrossRefs" href="#bib0600"><span class="elsevierStyleSup">53,54</span></a> Often after IV diuretics or ECUF there is neurohumoral activation due to intravascular volume depletion. Because peritoneal ultrafiltration has a minimal impact on hemodynamics, there is no sympathetic and RAAS response, which results in better preservation of residual renal function.<a class="elsevierStyleCrossRef" href="#bib0610"><span class="elsevierStyleSup">55</span></a> Peritoneal cavity access allows for drainage of ascitic fluid in cases of right-sided heart failure, reducing intra-abdominal pressure, which also improves renal function in HF.<a class="elsevierStyleCrossRef" href="#bib0615"><span class="elsevierStyleSup">56</span></a> There is also speculation that PD removes other harmful mediators such as tumor necrosis factor-alpha, interleukin-6 and myocardial depressant factor.<a class="elsevierStyleCrossRefs" href="#bib0620"><span class="elsevierStyleSup">57,58</span></a> Compared to ECUF, PD is not associated with myocardial stunning or vascular access complications such as catheter-related bloodstream infections, or negative effects on cardiac function due to high-flow arteriovenous fistulas.<a class="elsevierStyleCrossRef" href="#bib0600"><span class="elsevierStyleSup">53</span></a> Other advantages of PD are that it can be placed under local anesthesia, without needing to discontinue anticoagulation and antiplatelet therapy and can be used immediately, the ability to achieve overnight peritoneal ultrafiltration in patients with hernias without the need for hernia repair, and the low rate of complications such as peritonitis and catheter dysfunction.<a class="elsevierStyleCrossRefs" href="#bib0630"><span class="elsevierStyleSup">59,60</span></a> PD has also been shown to improve New York Heart Association functional class, reduce hospitalizations and mortality, and improve quality of life, in decompensated HF with or without mild kidney failure associated with type 2 cardiorenal syndrome (CRS).<a class="elsevierStyleCrossRefs" href="#bib0640"><span class="elsevierStyleSup">61–63</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Depending on the patient's need, a PD prescription can specifically target fluid removal, solute clearance, or both. In the setting of congestive HF, the primary focus with PD should be optimization of sodium removal, as sodium is the major determinant of extracellular volume. In order to achieve better volume management, sodium removal can be optimized in a dwell by eliminating the early phase, sodium sieving, using icodextrin. Fluid removal can be achieved with a single nocturnal peritoneal exchange with icodextrin in refractory diuretic-resistant HF.<a class="elsevierStyleCrossRef" href="#bib0655"><span class="elsevierStyleSup">64</span></a> With progression of CRS over time, the PD regimen can be gradually intensified by adding glucose-based solutions to provide more clearance and sodium removal. Continuous ambulatory PD has less frequent and longer cycles than automated PD (APD) and theoretically results in higher sodium removal. However, it is believed that with optimal PD prescription, the two modalities have similar results. Adding a manual daytime exchange to an APD regimen is another option to enhance sodium elimination.<a class="elsevierStyleCrossRef" href="#bib0660"><span class="elsevierStyleSup">65</span></a> In HF patients with hyponatremia, more frequent short dwells of hypertonic dialysate solutions can lead to high clearance of free water. Twice-daily 8-h icodextrin exchanges seem to be a promising approach for efficient decongestion in refractory HF. Some studies have shown an increase in ultrafiltration volume and ejection fraction as well as reduction in weight, blood pressure, N-terminal pro-brain natriuretic peptide, and left ventricular mass. However, for long-term use, close monitoring of serum sodium levels is recommended.<a class="elsevierStyleCrossRefs" href="#bib0665"><span class="elsevierStyleSup">66,67</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclusion</span><p id="par0075" class="elsevierStylePara elsevierViewall">In HF there is a compensatory activation of neurohormonal systems to maintain circulatory homeostasis, which leads to fluid overload. Diuretic therapy is still the cornerstone of therapy to prevent and treat congestion; however, with long-term treatment there is a decrease in its therapeutic effect. DR has emerged as an independent factor for worse outcomes in HF patients. There are some non-pharmacological measures and a few medical options to overcome DR. Adjustments to loop diuretic therapy, such as increasing doses and frequency of administration and sequential nephron blockade, may be successful. For hospitalized patients with progressive disease there are more invasive methods for fluid removal. PD can enable efficient management of fluid overload, preventing HF-related hospital admission, and improving quality of life. As a last resort for fluid removal, a PD regimen should fully exploit its decongestive properties and should be tailored to the patient's characteristics and clinical needs.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflicts of interest</span><p id="par0080" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres1957357" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1684539" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1957358" "titulo" => "Resumo" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1684538" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Management of diuretic resistance" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Conclusion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflicts of interest" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2021-10-23" "fechaAceptado" => "2022-05-09" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1684539" "palabras" => array:5 [ 0 => "Cardiorenal syndrome" 1 => "Heart failure" 2 => "Venous congestion" 3 => "Diuretic resistance" 4 => "Peritoneal dialysis" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec1684538" "palabras" => array:5 [ 0 => "Síndrome cardiorrenal" 1 => "Insuficiência cardíaca" 2 => "Congestão venosa" 3 => "Resistência a diuréticos" 4 => "Diálise peritoneal" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Acute heart failure (HF) decompensation generally manifests with signs and symptoms of congestion that strongly predict poor poor patient outcome. Loop diuretics are the cornerstone of therapy to counteract fluid overload and are widely used for acute management and chronic stabilization of HF. However, a diminished response to loop diuretics is a common problem, affecting the patient's clinical course and potentially prolonging hospitalization. Diuretic resistance is defined as failure to decongest despite appropriate and escalating loop diuretic therapy. We propose a protocol for the management of diuretic resistance. The initial approach should include an assessment of causes of pseudo-diuretic resistance. Adjustments to loop diuretic therapy, such as increasing doses and frequency of administration and sequential nephron blockade, may be successful. For hospitalized patients with progressive disease there are more invasive methods for fluid removal. Switching from oral to intravenous loop diuretics is essential to avoid variable absorption and for symptomatic relief. Extracorporeal ultrafiltration is also an option since this technique is highly effective at removing plasma fluid from blood. While extracorporeal ultrafiltration is an invasive solution, peritoneal dialysis is a home-based, intermittent therapeutic option that can enable efficient management of fluid overload, preventing HF-related hospital admission, and improving quality of life. As a last resort for fluid removal, a peritoneal dialysis regimen should fully exploit its decongestive properties and should be tailored to the patient's characteristics and clinical needs.</p></span>" ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A insuficiência cardíaca (IC) descompensada manifesta-se por sinais e sintomas de congestão, que são fortes preditores de mau prognóstico. Os diuréticos de ansa são a base do tratamento da sobrecarga hídrica nas descompensações agudas e na estabilização crónica, mas uma resposta diminuída aos mesmos é frequente na IC. Tal afeta o curso clínico e condicionais internamentos mais prolongados. A «resistência a diuréticos» é definida pela incapacidade em tratar sintomas congestivos, apesar da terapêutica adequada e crescente com diuréticos de ansa. Propomos um protocolo de atuação para ultrapassar esta resistência em que a abordagem inicial passa pela exclusão de causas de pseudo-resistência. Estratégias como o aumento da dose ou do número de administrações de diuréticos de ansa, ou o bloqueio sequencial do nefrónio, podem ser suficientes para aumentar a resposta diurética. Em doentes hospitalizados existem métodos mais invasivos para a remoção de fluidos. Nestes, a alteração de um diurético de ansa oral para endovenoso é uma abordagem fundamental para evitar a absorção errática e para o alívio sintomático. A ultrafiltração extracorporal é uma técnica invasiva muito eficaz na remoção de fluidos, que também pode ser uma opção terapêutica. A diálise peritoneal é um tratamento domiciliar intermitente que permite uma gestão eficiente da sobrecarga hídrica, evitando internamentos por IC descompensada e garantindo uma melhor qualidade de vida. A prescrição de diálise peritoneal para a remoção de fluidos, num doente sem resposta a outras medidas médicas, deve otimizar ao máximo a sua capacidade de ultrafiltração e deve ser adaptada às características do doente.</p></span>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3544 "Ancho" => 2508 "Tamanyo" => 552779 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Proposed protocol to treat diuretic resistant heart failure. NaCl: sodium chloride; SGLT2: sodium/glucose cotransporter 2; UNa+: urinary sodium; UO: urinary output.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:67 [ 0 => array:3 [ "identificador" => "bib0340" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Predictors of congestive heart failure in the elderly: the cardiovascular health study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J.S. Gottdiener" 1 => "A.M. Arnold" 2 => "G.P. Aurigemma" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0735-1097(00)00582-9" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2000" "volumen" => "35" "paginaInicial" => "1628" "paginaFinal" => "1637" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10807470" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0345" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Global public health burden of heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G. Savarese" 1 => "L.H. Lund" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.15420/cfr.2016:25:2" "Revista" => array:6 [ "tituloSerie" => "Card Fail Rev" "fecha" => "2017" "volumen" => "3" "paginaInicial" => "7" "paginaFinal" => "11" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28785469" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0350" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical course and predictive value of congestion during hospitalization in patients admitted for worsening signs and symptoms of heart failure with reduced ejection fraction: findings from the EVEREST trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A.P. Ambrosy" 1 => "P.S. Pang" 2 => "S. Khan" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Eur Heart J" "fecha" => "2013" "volumen" => "34" "paginaInicial" => "835" "paginaFinal" => "843" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0355" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Assessing and grading congestion in acute heart failure: a scientific statement from the acute heart failure committee of the heart failure association of the European Society of Cardiology and endorsed by the European Society of Intensive Care Medicine" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M. Gheorghiade" 1 => "F. Follath" 2 => "P. Ponikowski" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurjhf/hfq045" "Revista" => array:6 [ "tituloSerie" => "Eur J Heart Fail" "fecha" => "2010" "volumen" => "12" "paginaInicial" => "423" "paginaFinal" => "433" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20354029" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0360" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diuretic resistance in cardio-nephrology: role of pharmacokinetics, hypochloremia, and kidney remodeling" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "C. Masella" 1 => "D. Viggiano" 2 => "I. Molfino" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000502648" "Revista" => array:6 [ "tituloSerie" => "Kidney Blood Press Res" "fecha" => "2019" "volumen" => "44" "paginaInicial" => "915" "paginaFinal" => "927" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31437845" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0365" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diuretic therapy and resistance in congestive heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "D.H. Ellison" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Cardiology" "fecha" => "2001" "volumen" => "96" "paginaInicial" => "132" "paginaFinal" => "143" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0370" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Consensus recommendations for the management of chronic heart failure: introduction" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M. Packer" 1 => "J.N. Cohn" 2 => "W.T. Abraham" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Am J Cardiol" "fecha" => "1999" "volumen" => "83" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0375" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diuretic therapy in heart failure – current approaches" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G. Casu" 1 => "P. Merella" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.15420/ecr.2015.10.01.42" "Revista" => array:6 [ "tituloSerie" => "Eur Cardiol" "fecha" => "2015" "volumen" => "10" "paginaInicial" => "42" "paginaFinal" => "47" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30310422" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0380" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diuretic response in acute heart failure: clinical characteristics prognostic significance" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M.A.E. Valente" 1 => "A.A. Voors" 2 => "K. Damman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Eur Heart J" "fecha" => "2014" "volumen" => "35" "paginaInicial" => "1093" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0385" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A 2018 overview of diuretic resistance in heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S.I. Jardim" 1 => "L. Ramos dos Santos" 2 => "I. Araújo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Port Cardiol" "fecha" => "2018" "volumen" => "37" "paginaInicial" => "935" "paginaFinal" => "945" ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0390" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diuretic resistance in acute decompensated heart failure: a challenging clinical conundrum" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "B.N. Reed" 1 => "S. Devabhakthuni" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Crit Care Nurs Q" "fecha" => "2017" "volumen" => "40" "paginaInicial" => "363" "paginaFinal" => "373" ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0395" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diuretic resistance in heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R. Gupta" 1 => "J. Testani" 2 => "S. Collins" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Curr Heart Fail Rep" "fecha" => "2019" "volumen" => "16" "paginaInicial" => "57" "paginaFinal" => "66" ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0400" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diuretic response in acute heart failure – an analysis from ASCEND-HF" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J.M. Ter Maaten" 1 => "A.M. Dunning" 2 => "M.A.E. Valente" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Am Heart J" "fecha" => "2015" "volumen" => "170" ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0405" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A perspective on diuretic resistance in chronic congestive heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "N. Shah" 1 => "R. Madanieh" 2 => "M. Alkan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/1753944717718717" "Revista" => array:6 [ "tituloSerie" => "Ther Adv Cardiovasc Dis" "fecha" => "2017" "volumen" => "11" "paginaInicial" => "271" "paginaFinal" => "278" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28728476" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0410" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Insufficient natriuretic response to continuous intravenous furosemide is associated with poor long-term outcomes in acute decompensated heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "D. Singh" 1 => "K. Shrestha" 2 => "J.M. Testani" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.cardfail.2014.03.006" "Revista" => array:6 [ "tituloSerie" => "J Card Fail" "fecha" => "2014" "volumen" => "20" "paginaInicial" => "392" "paginaFinal" => "399" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24704538" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0415" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The use of diuretics in heart failure with congestion – a position statement from the Heart Failure Association of the European Society of Cardiology" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "W. Mullens" 1 => "K. Damman" 2 => "V.P. Harjola" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/ejhf.1369" "Revista" => array:6 [ "tituloSerie" => "Eur J Heart Fail" "fecha" => "2019" "volumen" => "21" "paginaInicial" => "137" "paginaFinal" => "155" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30600580" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0420" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fractional excretion of sodium and its association with prognosis of decompensated heart failure patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D. Kumar" 1 => "R. Bagarhatta" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "J Clin Diagn Res" "fecha" => "2015" "volumen" => "9" ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0425" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hypochloremia, diuretic resistance, and outcome in patients with acute heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J.M. Ter Maaten" 1 => "K. Damman" 2 => "J.S. Hanberg" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Circ Hear Fail" "fecha" => "2016" "volumen" => "9" "paginaInicial" => "3109" ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0430" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Furosemide absorption altered in decompensated congestive heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M.R. Vasko" 1 => "D.B. Cartwright" 2 => "J.P. Knochel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.7326/0003-4819-102-3-314" "Revista" => array:6 [ "tituloSerie" => "Ann Intern Med" "fecha" => "1985" "volumen" => "102" "paginaInicial" => "314" "paginaFinal" => "318" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3970471" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0435" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bioavailability, pharmacokinetics, and pharmacodynamics of torsemide and furosemide in patients with congestive heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "D.L. Vargo" 1 => "W.G. Kramer" 2 => "P.K. Black" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/0009-9236(95)90222-8" "Revista" => array:6 [ "tituloSerie" => "Clin Pharmacol Ther" "fecha" => "1995" "volumen" => "57" "paginaInicial" => "601" "paginaFinal" => "609" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7781259" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0440" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Incidence of renal dysfunction over 6 months in patients with chronic heart failure due to left ventricular systolic dysfunction: contributing factors and relationship to prognosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "R. De Silva" 1 => "N.P. Nikitin" 2 => "K.K.A. Witte" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/ehi696" "Revista" => array:6 [ "tituloSerie" => "Eur Heart J" "fecha" => "2006" "volumen" => "27" "paginaInicial" => "569" "paginaFinal" => "581" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16364971" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0445" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diuretic resistance and strategies to overcome resistance in patients with congestive heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S.L. Ravnan" 1 => "M.C. Ravnan" 2 => "P.C. Deedwania" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Congest Heart Fail" "fecha" => "2002" "volumen" => "8" "paginaInicial" => "80" "paginaFinal" => "85" ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0450" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diuretic resistance: physiology and therapeutics" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "D.H. Ellison" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Semin Nephrol" "fecha" => "1999" "volumen" => "19" "paginaInicial" => "581" "paginaFinal" => "597" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10598546" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0455" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The role of renin angiotensin system intervention in stage B heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "P. Collier" 1 => "K.M. McDonald" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.hfc.2011.11.006" "Revista" => array:6 [ "tituloSerie" => "Heart Fail Clin" "fecha" => "2012" "volumen" => "8" "paginaInicial" => "225" "paginaFinal" => "236" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22405662" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0460" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Localization of diuretic effects along the loop of Henle: an in vivo microperfusion study in rats" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "R.J. Unwin" 1 => "S.J. Walter" 2 => "G. Giebisch" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Clin Sci" "fecha" => "2000" "volumen" => "98" "paginaInicial" => "481" "itemHostRev" => array:3 [ "pii" => "S147020451830322X" "estado" => "S300" "issn" => "14702045" ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0465" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Loop diuretic resistance in heart failure: resistance etiology-based strategies to restoring diuretic efficacy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Z.L. Cox" 1 => "D.J. Lenihan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.cardfail.2014.05.007" "Revista" => array:6 [ "tituloSerie" => "J Card Fail" "fecha" => "2014" "volumen" => "20" "paginaInicial" => "611" "paginaFinal" => "622" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24879974" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0470" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of loop diuretic resistance in the intensive care unit" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "K. Asare" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Am J Heal Pharm" "fecha" => "2009" "volumen" => "66" "paginaInicial" => "1635" "paginaFinal" => "1640" ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0475" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diuretic resistance and its management" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J. Iqbal" 1 => "M.M. Javaid" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Br J Hosp Med" "fecha" => "2014" "volumen" => "75" ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0480" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "High-dose furosemide in the treatment of refractory congestive heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "P.G.G. Gerlag" 1 => "J.J.M. Van Meijel" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Intern Med" "fecha" => "1988" "volumen" => "148" "paginaInicial" => "286" "paginaFinal" => "291" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3341836" "web" => "Medline" ] ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0485" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mechanisms and management of diuretic resistance in congestive heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "L.K.M. De Bruyne" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Postgrad Med J" "fecha" => "2003" "volumen" => "79" "paginaInicial" => "268" "paginaFinal" => "271" ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0490" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diuretic efficacy of high dose furosemide in severe heart failure: bolus injection versus continuous infusion" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "T.P.J. Dormans" 1 => "J.J.M. Van Meyel" 2 => "P.G.G. Gerlag" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/0735-1097(96)00161-1" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "1996" "volumen" => "28" "paginaInicial" => "376" "paginaFinal" => "382" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8800113" "web" => "Medline" ] ] ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0495" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Continuous versus intermittent infusion of furosemide in acute decompensated heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M.R. Thomson" 1 => "J.M. Nappi" 2 => "S.P. Dunn" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.cardfail.2009.11.005" "Revista" => array:6 [ "tituloSerie" => "J Card Fail" "fecha" => "2010" "volumen" => "16" "paginaInicial" => "188" "paginaFinal" => "193" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20206891" "web" => "Medline" ] ] ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0500" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Subcutaneous furosemide for the treatment of heart failure: a state-of-the art review" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M.E. Afari" 1 => "J. Aoun" 2 => "S. Khare" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10741-018-9760-6" "Revista" => array:6 [ "tituloSerie" => "Heart Fail Rev" "fecha" => "2019" "volumen" => "24" "paginaInicial" => "309" "paginaFinal" => "313" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30617666" "web" => "Medline" ] ] ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib0505" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diuretic effectiveness of hydrochlorothiazide and furosemide alone and in combination in chronic renal failure" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "H. Knauf" 1 => "E. Mutschler" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/00005344-199509000-00008" "Revista" => array:7 [ "tituloSerie" => "J Cardiovasc Pharmacol" "fecha" => "1995" "volumen" => "26" "paginaInicial" => "394" "paginaFinal" => "400" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8583780" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0923753419322483" "estado" => "S300" "issn" => "09237534" ] ] ] ] ] ] ] 34 => array:3 [ "identificador" => "bib0510" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mechanism of impaired natriuretic response to furosemide during prolonged therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "N.R. Loon" 1 => "C.S. Wilcox" 2 => "R.J. Unwin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/ki.1989.246" "Revista" => array:6 [ "tituloSerie" => "Kidney Int" "fecha" => "1989" "volumen" => "36" "paginaInicial" => "682" "paginaFinal" => "689" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2811065" "web" => "Medline" ] ] ] ] ] ] ] ] 35 => array:3 [ "identificador" => "bib0515" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Metolazone and its role in edema management" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "D.A. Sica" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1527-5299.2003.01907.x" "Revista" => array:6 [ "tituloSerie" => "Congest Heart Fail" "fecha" => "2003" "volumen" => "9" "paginaInicial" => "100" "paginaFinal" => "105" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12671341" "web" => "Medline" ] ] ] ] ] ] ] ] 36 => array:3 [ "identificador" => "bib0520" "etiqueta" => "37" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of cardio-renal syndrome and diuretic resistance" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "F.H. Verbrugge" 1 => "W. Mullens" 2 => "W.H.W. Tang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s11936-015-0423-9" "Revista" => array:6 [ "tituloSerie" => "Curr Treat Options Cardiovasc Med" "fecha" => "2016" "volumen" => "18" "paginaInicial" => "1" "paginaFinal" => "15" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26706849" "web" => "Medline" ] ] ] ] ] ] ] ] 37 => array:3 [ "identificador" => "bib0525" "etiqueta" => "38" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treating diuretic resistance: an overview" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "B.N. Bowman" 1 => "J.J. Nawarskas" 2 => "J.R. Anderson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Cardiol Rev" "fecha" => "2016" "volumen" => "24" "paginaInicial" => "256" "paginaFinal" => "260" ] ] ] ] ] ] 38 => array:3 [ "identificador" => "bib0530" "etiqueta" => "39" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Efficacy and safety of spironolactone in acute heart failure: the ATHENA-HF randomized clinical trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J. Butler" 1 => "K.J. Anstrom" 2 => "G.M. Felker" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "JAMA Cardiol" "fecha" => "2017" "volumen" => "2" "paginaInicial" => "950" "paginaFinal" => "958" ] ] ] ] ] ] 39 => array:3 [ "identificador" => "bib0535" "etiqueta" => "40" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Spironolactone in congestive heart failure refractory to high-dose loop diuretic and low-dose angiotensin-converting enzyme inhibitor" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A.A. van Vliet" 1 => "A.J.M. Donker" 2 => "J.J.P. Nauta" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/0002-9149(93)90241-4" "Revista" => array:3 [ "tituloSerie" => "Am J Cardiol" "fecha" => "1993" "volumen" => "71" ] ] ] ] ] ] 40 => array:3 [ "identificador" => "bib0540" "etiqueta" => "41" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Therapeutic potential of vasopressin-receptor antagonists in heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "Y. Izumi" 1 => "K. Miura" 2 => "H. Iwao" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Pharmacol Sci" "fecha" => "2014" "volumen" => "124" "paginaInicial" => "1" "paginaFinal" => "6" ] ] ] ] ] ] 41 => array:3 [ "identificador" => "bib0545" "etiqueta" => "42" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Short-term clinical effects of tolvaptan, an oral vasopressin antagonist, in patients hospitalized for heart failure: the EVEREST clinical status trials" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M.D. Cheitlin" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Yearb Cardiol" "fecha" => "2008" "volumen" => "2008" "paginaInicial" => "382" "paginaFinal" => "384" ] ] ] ] ] ] 42 => array:3 [ "identificador" => "bib0550" "etiqueta" => "43" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Haemodynamic effects of diuretics in heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "E.B. Raftery" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Heart" "fecha" => "1994" "volumen" => "72" "numero" => "Suppl." "paginaInicial" => "44" "paginaFinal" => "47" ] ] ] ] ] ] 43 => array:3 [ "identificador" => "bib0555" "etiqueta" => "44" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diuretic strategies in patients with acute decompensated heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "G.M. Felker" 1 => "K.L. Lee" 2 => "D.A. Bull" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "N Engl J Med" "fecha" => "2011" "volumen" => "364" "paginaInicial" => "797" "paginaFinal" => "805" ] ] ] ] ] ] 44 => array:3 [ "identificador" => "bib0560" "etiqueta" => "45" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Simultaneous use of hypertonic saline and IV furosemide for fluid overload: a systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "C. Liu" 1 => "Z. Peng" 2 => "X. Gao" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/CCM.0000000000005174" "Revista" => array:6 [ "tituloSerie" => "Crit Care Med" "fecha" => "2021" "volumen" => "49" "paginaInicial" => "e1163" "paginaFinal" => "e1175" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34166286" "web" => "Medline" ] ] ] ] ] ] ] ] 45 => array:3 [ "identificador" => "bib0565" "etiqueta" => "46" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Does albumin infusion improve loop diuretic efficacy and reduce third spacing in patients treated for acute heart failure? Case series and literature review" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M.D. Phillips" 1 => "D.M. Thomas" 2 => "C.A. Bolduc" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Austin J Cardiovasc Dis Atherosclerosis" "fecha" => "2014" "volumen" => "1" "paginaInicial" => "2" ] ] ] ] ] ] 46 => array:3 [ "identificador" => "bib0570" "etiqueta" => "47" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Early ultrafiltration in patients with decompensated heart failure and diuretic resistance" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M.R. Costanzo" 1 => "M. Saltzberg" 2 => "J. O'Sullivan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2005.05.099" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2005" "volumen" => "46" "paginaInicial" => "2047" "paginaFinal" => "2051" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16325040" "web" => "Medline" ] ] ] ] ] ] ] ] 47 => array:3 [ "identificador" => "bib0575" "etiqueta" => "48" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ultrafiltration versus usual care for hospitalized patients with heart failure: the relief for acutely fluid-overloaded patients with decompensated congestive heart failure (RAPID-CHF) trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "B.A. Bart" 1 => "A. Boyle" 2 => "A.J. Bank" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2005.05.098" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2005" "volumen" => "46" "paginaInicial" => "2043" "paginaFinal" => "2046" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16325039" "web" => "Medline" ] ] ] ] ] ] ] ] 48 => array:3 [ "identificador" => "bib0580" "etiqueta" => "49" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ultrafiltration versus intravenous diuretics for patients hospitalized for acute decompensated heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M.R. Costanzo" 1 => "M.E. Guglin" 2 => "M.T. Saltzberg" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2006.07.073" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2007" "volumen" => "49" "paginaInicial" => "675" "paginaFinal" => "683" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17291932" "web" => "Medline" ] ] ] ] ] ] ] ] 49 => array:3 [ "identificador" => "bib0585" "etiqueta" => "50" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effects of ULTRAfiltration vs. DIureticS on clinical, biohumoral and haemodynamic variables in patients with deCOmpensated heart failure: The ULTRADISCO study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "C. Giglioli" 1 => "D. Landi" 2 => "E. Cecchi" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Eur J Heart Fail" "fecha" => "2011" "volumen" => "13" "paginaInicial" => "337" "paginaFinal" => "346" ] ] ] ] ] ] 50 => array:3 [ "identificador" => "bib0590" "etiqueta" => "51" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Continuous ultrafiltration for congestive heart failure: the CUORE trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "G. Marenzi" 1 => "M. Muratori" 2 => "E.R. Cosentino" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Card Fail" "fecha" => "2014" "volumen" => "20" "paginaInicial" => "9" "paginaFinal" => "17" ] ] ] ] ] ] 51 => array:3 [ "identificador" => "bib0595" "etiqueta" => "52" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ultrafiltration in decompensated heart failure with cardiorenal syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "B.A. Bart" 1 => "S.R. Goldsmith" 2 => "K.L. Lee" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa1210357" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2012" "volumen" => "367" "paginaInicial" => "2296" "paginaFinal" => "2304" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23131078" "web" => "Medline" ] ] ] ] ] ] ] ] 52 => array:3 [ "identificador" => "bib0600" "etiqueta" => "53" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Peritoneal dialysis for chronic congestive heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "K. François" 1 => "C. Ronco" 2 => "J.M. Bargman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000430084" "Revista" => array:6 [ "tituloSerie" => "Blood Purif" "fecha" => "2015" "volumen" => "40" "paginaInicial" => "45" "paginaFinal" => "52" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26111872" "web" => "Medline" ] ] ] ] ] ] ] ] 53 => array:3 [ "identificador" => "bib0605" "etiqueta" => "54" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Peritoneal dialysis in patients with refractory congestive heart failure: a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "R. Lu" 1 => "M.J. Muciño-Bermejo" 2 => "L.C. Ribeiro" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Cardiorenal Med" "fecha" => "2015" "volumen" => "5" "paginaInicial" => "145" "paginaFinal" => "156" ] ] ] ] ] ] 54 => array:3 [ "identificador" => "bib0610" "etiqueta" => "55" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Novel therapeutic option for refractory heart failure in elderly patients with chronic kidney disease by incremental peritoneal dialysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Nakayama" 1 => "H. Nakano" 2 => "M. Nakayama" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jjcc.2009.08.003" "Revista" => array:6 [ "tituloSerie" => "J Cardiol" "fecha" => "2010" "volumen" => "55" "paginaInicial" => "49" "paginaFinal" => "54" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20122548" "web" => "Medline" ] ] ] ] ] ] ] ] 55 => array:3 [ "identificador" => "bib0615" "etiqueta" => "56" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prompt reduction in intra-abdominal pressure following large-volume mechanical fluid removal improves renal insufficiency in refractory decompensated heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "W. Mullens" 1 => "Z. Abrahams" 2 => "G.S. Francis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.cardfail.2008.02.010" "Revista" => array:6 [ "tituloSerie" => "J Card Fail" "fecha" => "2008" "volumen" => "14" "paginaInicial" => "508" "paginaFinal" => "514" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18672199" "web" => "Medline" ] ] ] ] ] ] ] ] 56 => array:3 [ "identificador" => "bib0620" "etiqueta" => "57" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ultrafiltration therapy for cardiorenal syndrome: physiologic basis and contemporary options" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "E.A. Ross" 1 => "A. Kazory" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000342080" "Revista" => array:6 [ "tituloSerie" => "Blood Purif" "fecha" => "2012" "volumen" => "34" "paginaInicial" => "149" "paginaFinal" => "157" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23095414" "web" => "Medline" ] ] ] ] ] ] ] ] 57 => array:3 [ "identificador" => "bib0625" "etiqueta" => "58" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Preservation of residual kidney function in hemodialysis patients: reviving an old concept for contemporary practice" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A.T. Mathew" 1 => "S. Fishbane" 2 => "Y. Obi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.kint.2016.02.037" "Revista" => array:6 [ "tituloSerie" => "Kidney Int" "fecha" => "2018" "volumen" => "90" "paginaInicial" => "262" "paginaFinal" => "271" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27182000" "web" => "Medline" ] ] ] ] ] ] ] ] 58 => array:3 [ "identificador" => "bib0630" "etiqueta" => "59" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Laparoscopic implantation of the Tenckhoff catheter for the treatment of end-stage renal failure and congestive heart failure: experience with the pelvic fixation technique" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "D. Bar-Zohar" 1 => "B. Sagie" 2 => "N. Lubezky" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Isr Med Assoc J" "fecha" => "2006" "volumen" => "8" "paginaInicial" => "174" "paginaFinal" => "178" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16599052" "web" => "Medline" ] ] ] ] ] ] ] ] 59 => array:3 [ "identificador" => "bib0635" "etiqueta" => "60" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Peritoneal dialysis relieves clinical symptoms and is well tolerated in patients with refractory heart failure and chronic kidney disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M. Koch" 1 => "B. Haastert" 2 => "M. Kohnle" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurjhf/hfs035" "Revista" => array:6 [ "tituloSerie" => "Eur J Heart Fail" "fecha" => "2012" "volumen" => "14" "paginaInicial" => "530" "paginaFinal" => "539" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22447950" "web" => "Medline" ] ] ] ] ] ] ] ] 60 => array:3 [ "identificador" => "bib0640" "etiqueta" => "61" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Continuous ambulatory peritoneal dialysis as a therapeutic alternative in patients with advanced congestive heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J. Núñez" 1 => "M. González" 2 => "G. Miñana" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurjhf/hfs013" "Revista" => array:6 [ "tituloSerie" => "Eur J Heart Fail" "fecha" => "2012" "volumen" => "14" "paginaInicial" => "540" "paginaFinal" => "548" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22327061" "web" => "Medline" ] ] ] ] ] ] ] ] 61 => array:3 [ "identificador" => "bib0645" "etiqueta" => "62" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prospective study on clinical effects of renal replacement therapy in treatment-resistant congestive heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "T.T. Cnossen" 1 => "J.P. Kooman" 2 => "H.P. Krepel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/ndt/gfr756" "Revista" => array:6 [ "tituloSerie" => "Nephrol Dial Transplant" "fecha" => "2012" "volumen" => "27" "paginaInicial" => "2794" "paginaFinal" => "2799" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22492829" "web" => "Medline" ] ] ] ] ] ] ] ] 62 => array:3 [ "identificador" => "bib0650" "etiqueta" => "63" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Peritoneal ultrafiltration in refractory heart failure: a cohort study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S.V. Bertoli" 1 => "C. Musetti" 2 => "D. Ciurlino" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3747/pdi.2012.00290" "Revista" => array:6 [ "tituloSerie" => "Perit Dial Int" "fecha" => "2014" "volumen" => "34" "paginaInicial" => "64" "paginaFinal" => "70" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24179103" "web" => "Medline" ] ] ] ] ] ] ] ] 63 => array:3 [ "identificador" => "bib0655" "etiqueta" => "64" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Efficacy of peritoneal dialysis with icodextrin in the long-term treatment of refractory congestive heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "C. Basile" 1 => "D. Chimienti" 2 => "A. Bruno" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Perit Dial Int" "fecha" => "2009" "volumen" => "29" "paginaInicial" => "116" "paginaFinal" => "118" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19164263" "web" => "Medline" ] ] ] ] ] ] ] ] 64 => array:3 [ "identificador" => "bib0660" "etiqueta" => "65" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sodium removal and peritoneal dialysis modalities: no differences with optimal prescription of icodextrin" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "C. Fourtounas" 1 => "P. Dousdampanis" 2 => "A. Hardalias" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/aor.12061" "Revista" => array:3 [ "tituloSerie" => "Artif Organs" "fecha" => "2013" "volumen" => "37" ] ] ] ] ] ] 65 => array:3 [ "identificador" => "bib0665" "etiqueta" => "66" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bimodal solutions or twice-daily icodextrin to enhance ultrafiltration in peritoneal dialysis patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "P. Dousdampanis" 1 => "K. Trigka" 2 => "J.M. Bargman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1155/2013/424915" "Revista" => array:3 [ "tituloSerie" => "Int J Nephrol" "fecha" => "2013" "volumen" => "2013" ] ] ] ] ] ] 66 => array:3 [ "identificador" => "bib0670" "etiqueta" => "67" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Customization of peritoneal dialysis in cardiorenal syndrome by optimization of sodium extraction" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Kazory" 1 => "A. Koratala" 2 => "C. Ronco" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Cardiorenal Med" "fecha" => "2019" "volumen" => "9" "paginaInicial" => "117" "paginaFinal" => "124" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/08702551/0000004200000009/v1_202309041131/S0870255123001646/v1_202309041131/en/main.assets" "Apartado" => array:4 [ "identificador" => "93365" "tipo" => "SECCION" "pt" => array:2 [ "titulo" => "State of the Art" "idiomaDefecto" => true ] "idiomaDefecto" => "pt" ] "PDF" => "https://static.elsevier.es/multimedia/08702551/0000004200000009/v1_202309041131/S0870255123001646/v1_202309041131/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255123001646?idApp=UINPBA00004E" ]
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