diuretic resistance in kidney disease .pdf

Biomedicine & Pharmacotherapy 157 (2023) 114058 Contents lists available at ScienceDirect Biomedicine & Pharmacotherapy...

Biomedicine & Pharmacotherapy 157 (2023) 114058 Contents lists available at ScienceDirect Biomedicine & Pharmacotherapy journal homepage: www.elsevier.com/locate/biopha Review Diuretic resistance in patients with kidney disease: Challenges and opportunities Luxuan Guo a, b, c, Baohui Fu a, b, c, Yang Liu a, b, c, Na Hao a, b, c, Yue Ji a, b, c, Hongtao Yang a, b, c, * a First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300193, China b National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin 300193, China c Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China A R T I C L E I N F O A B S T R A C T Keywords: Edema caused by kidney disease is called renal edema. Edema is a common symptom of many human kidney Diuretic resistance diseases. Patients with renal edema often need to take diuretics.However, After taking diuretics, patients with Patients with kidney diseases kidney diseases are prone to kidney congestion, decreased renal perfusion, decreased diuretics secreted by renal Pathogenesis tubules, neuroendocrine system abnormalities, abnormal ion transporter transport, drug interaction, electrolyte Treatment strategies disorder, and hypoproteinemia, which lead to ineffective or weakened diuretic use and increase readmission rate Drug and mortality. The main causes and coping strategies of diuretic resistance in patients with kidney diseases were described in detail in this report. The common causes of DR included poor diet (electrolyte disturbance and hypoproteinemia due to patients’ failure to limit diet according to correct sodium, chlorine, potassium, and protein level) and poor drug compliance (the patient did not take adequate doses of diuretics. true resistance occurs only if the patient takes adequate doses of diuretics, but they are not effective), changes in pharmaco­ kinetics and pharmacodynamics, electrolyte disorders, changes in renal adaptation, functional nephron reduc­ tion, and decreased renal blood flow. Common treatment measures include increasing in the diuretic dose and/or frequency, sequential nephron blockade,using new diuretics, ultrafiltration treatment, etc. In clinical work, measures should be taken to prevent or delay the occurrence and development of DR in patients with kidney diseases according to the actual situation of patients and the mechanism of various causes. Currently, there are many studies on DR in patients with heart diseases. Although the phenomenon of DR in patients with kidney diseases is common, there is a relatively little overview of the mechanism and treatment strategy of DR in pa­ tients with kidney diseases. Therefore, this paper hopes to show the information on DR in patients with kidney diseases to clinicians and researchers and broaden the research direction and ideas to a certain extent. 1. Introduction independent criteria for DR in AHF include (1) fractional excretion of sodium (FENa)< 0.2 % (2) urinary Na+