The goals of diuresis in heart failure are multifaceted and primarily focus on alleviating symptoms, improving patient outcomes, and preventing complications:
Symptom relief and congestion management
- Alleviation of symptoms: Diuretics are initiated to relieve congestion and improve symptoms in patients with heart failure (HF) who have fluid retention
- Management of congestion: The primary goal of therapy in patients with acute heart failure (AHF) characterized by congestion and volume overload is the relief of congestion through achieving a state of euvolemia, mainly through the use of diuretic therapy
Improvement of clinical outcomes
- Reduction of hospitalizations: Diuretics should reduce HF hospitalizations in patients with NYHA class II–IV HFrEF (LVEF ≤ 40%) with signs and/or symptoms of congestion
- Prevention of worsening HF: Diuretics are initiated to prevent worsening heart failure in patients with HF having fluid retention
Management of renal function
- Consideration of renal function: The occurrence of worsening renal function (WRF) in patients with AHF should be considered in the context of diuretic response. Substantial diuresis after administration of loop diuretics is generally associated with better clinical outcomes but may cause creatinine to rise, suggesting renal function decline
Monitoring and adjustment of therapy
- Monitoring of electrolytes and renal function: Daily serum electrolytes, urea nitrogen, and creatinine measurements are recommended during the use of IV diuretics or active titration of HF medications
- Adjustment of diuretics: A plan for adjustment of diuretics in the discharge regimen is recommended to decrease rehospitalizations in patients requiring diuretic treatment during hospitalization for HF
In conclusion, the goals of diuresis in heart failure are to alleviate symptoms, manage congestion, improve clinical outcomes, consider renal function, and adjust therapy as needed. These goals are achieved through careful monitoring and adjustment of diuretic therapy, taking into account the patient's individual response and renal function.