Review ArticlesDiuretic Resistance in Heart FailureRahman, Rubayat MD*; Paz, Pablo MD*; Elmassry, Mohamed MD*; Mantilla, Barbara MD*; Dobbe, Logan MD†; Shurmur, Scott MD*; Nugent, Kenneth MD*Author Information From the *Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX; and †Department of Graduate Medical Education, Madigan Army Medical Center, Tacoma, WA. Disclosure: The authors have no conflicts of interest to report. Correspondence: Kenneth Nugent, MD, Department of Internal Medicine, Texas Tech University Health Sciences Center, 3601 4th Street, Lubbock, TX 79430. E-mail: [email protected] Cardiology in Review: March/April 2021 - Volume 29 - Issue 2 - p 73-81 doi: 10.1097/CRD.0000000000000310 Buy Metrics Abstract Decompensated heart failure accounts for approximately 1 million hospitalizations in the United States annually, and this number is expected to increase significantly in the near future. Diuretics provide the initial management in most patients with fluid overload. However, the development of diuretic resistance remains a significant challenge in the treatment of heart failure. Due to the lack of a standard definition, the prevalence of this phenomenon remains difficult to determine, with some estimates suggesting that 25–30% of patients with heart failure have diuretic resistance. Certain characteristics, including low systolic blood pressures, renal impairment, and atherosclerotic disease, help predict the development of diuretic resistance. The underlying pathophysiology is likely multifactorial, with pharmacokinetic alterations, hormonal dysregulation, and the cardiorenal syndrome having significant roles. The therapeutic approach to this common problem typically involves increases in the diuretic dose and/or frequency, sequential nephron blockade, and mechanical fluid movement removal with ultrafiltration or peritoneal dialysis. Paracentesis is potentially useful in patients with intra-abdominal hypertension. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.