Diuretic Resistance in Kidney Diseases

Diuretic Resistance

• Diuretic resistance (DR) is a common issue in patients with kidney diseases and renal edema.
• DR occurs when diuretics become ineffective or weakened in treating edema.
• DR increases the risk of readmission and mortality in patients with kidney diseases.

Causes of Diuretic Resistance

• Poor Diet:
  • Electrolyte disturbance
  • Hypoproteinemia
• Poor Drug Compliance:
  • Inadequate diuretic dosage
• Pharmacokinetic and Pharmacodynamic Changes:
  • Altered drug absorption, distribution, metabolism, and excretion
  • Reduced drug effectiveness
• Electrolyte Disorders:
  • Alterations in sodium, potassium, and other electrolyte levels
• Renal Adaptation:
  • Changes in kidney's response to diuretics over time
• Functional Nephron Reduction:
  • Decreased number of functioning nephrons, leading to reduced diuretic action
• Decreased Renal Blood Flow:
  • Inadequate blood supply to the kidneys, impairing diuretic efficacy

Treatment Strategies for Diuretic Resistance

• Increasing Diuretic Dose and/or Frequency:
  • Enhancing diuretic effect by increasing dosage or administration frequency
• Sequential Nephron Blockade:
  • Using multiple diuretics with different mechanisms of action
• New Diuretics:
  • Exploring effective newer diuretics with improved efficacy
• Ultrafiltration Treatment:
  • Removing excess fluid from the body through a filtration process

Research and Future Directions

• Research on DR in patients with heart disease is extensive.
• However, comprehensive research on the mechanisms and treatment strategies for DR specifically in patients with kidney diseases is limited.
• This review aims to bridge this gap by providing information to clinicians and researchers, potentially expanding research avenues and ideas.