In patients with anuritic heart failure, should diuretics be used?

Diuretics are the cornerstone of the treatment of heart failure, can promote urinary sodium excretion, eliminate water sodium retention, for patients with fluid retention of heart failure, the application of diuretics is beyond doubt, but for patients with anuritic heart failure, diuretics are still necessary?

Diuretics are commonly used clinically

A common cause of anuria in patients with heart failure

There are two main reasons for the development of anuria in patients with heart failure:

First, there is a history of uremia itself, causing heart failure, this cause is best with the help of hemodialysis or peritoneal dialysis, in some patients with uremia dialysis with a certain residual renal function, loop diuretics still have a certain diuretic effect, can try to use, in order to reduce the load of dialysis dehydration.

The second is diuretic resistance, which is also a common cause of anutia in patients with clinical heart failure. In the face of diuretic resistance, the cause of diuretic resistance needs to be corrected first, and if there is still no significant change in the patient's urine output after correction, a strong combination of diuretics of different mechanisms of action is required to reduce diuretic resistance.

In patients with anuritic heart failure, should diuretics be used?

Excluding uremia, patients with heart failure are still anaficia after correcting the possible causes of diuretic resistance and adjusting the medication, is it necessary for us to use diuretics at this time?

The answer is yes, precisely because diuretics have a vasodilatory effect in addition to diuresis.

At the onset of heart failure, due to water and sodium retention, the content of Na in the vascular wall increases, and through na-Ca exchange, the ca in the vascular smooth muscle cells is added, which promotes vasoconstriction and increases the responsiveness of the vascular wall to the vasopressor substance, and the peripheral vascular resistance is increased, which can aggravate the symptoms of heart failure.

In patients with heart failure, diuretics can exert vasodilatory effects in the following 2 ways:

Promote the excretion of Na and, through the Na -Ca exchange mechanism, reduce the content of Ca in the vascular wall, so that the vascular wall tension decreases, peripheral resistance decreases, further reduces cardiac afterload, reduces symptoms of cardiac insufficiency;

By promoting the excretion of water and sodium, the sodium and water content in the blood vessel wall are reduced, thereby reducing the edema of the wall and the narrowing of the lumen caused by excessive accumulation of intracellular fluid.

Even in patients with anutia, loop diuretics can increase the content of prostaglandin E and dilate blood vessels by inhibiting the activity of prostaglandin-breaking enzymes;

This can dilate arterioles, reduce renal vascular resistance, increase renal blood flow, and dilate small venules, reduce left ventricular filling pressure in heart failure, reduce lung congestion, and these effects occur before the emergence of diuretic effects.

In summary, for patients with heart failure, whether there is urine or no urine, the application of diuretics can reduce the symptoms of heart failure to a certain extent, and in clinical work, it should be combined with the actual situation and flexible.

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Curated: ly

This article was first published on Lilac Garden's professional platform: Cardiovascular Time