Diuretika bei akuter Herzinsuffizienz – sinnvolle Therapie oder notwendiges Übel?

Abstract

Data from retrospective studies suggested that the intensive use of diuretics may lead to increased mortality in patients with acute decompensated heart failure (ADHF). Recently, various studies have been published dealing with the role of diuretics in ADHF: The prospective, randomized DOSE trial could show that diuretics do not increase mortality in ADHF patients even when given in higher doses or as a continuous infusion. Moreover, analysis of data from the ESCAPE and BEST study show that aggressive decongestion of ADHF patients reduced long-term mortality in patients with preserved renal function. Patients with reduced renal function, however, may not benefit from high-dose diuretic therapy. In those patients, alternative therapeutic strategies such as intermittent hemofiltration may be of value.

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