Correspondence
Treatment With Diuretics not Sufficiently Discussed
I would like to thank the authors for their well-balanced presentation of the available evidence. In my opinion, however, one topic of importance for clinical practice would have deserved more detailed discussion in the article (1): Diuretic therapy is mentioned only in passing. It ought to be tailored to the patient‘s symptoms. As a matter of fact, a significant proportion of patients with chronic heart failure receive long-term treatment with diuretics. In daily clinical practice, there are many questions arising about diuretic therapy. Examples include: Which class of diuretics should be preferred under what circumstances? What parameters that can be measured on an outpatient basis are suitable for volume status monitoring and thus dose adaption? What is the significance of drug combinations, the so-called sequential nephron blockade? What implications does this have for the need to monitor electrolyte levels and the frequency of testing (hypokalemia, hyponatremia)? What is the importance of limiting salt consumption and fluid intake? I had hoped that this review would present the best available evidence related to these questions which are of importance in clinical practice (2). Perhaps there are only few controlled trials exploring these issues (3). If this is the case, the need for further research in this field would have to be specified.
DOI: 10.3238/arztebl.m2021.0047
Dr. med. Rainer Burkhardt
Oldenburg
Germany
rainer.burkhardt@ewetel.net
Conflict of interest
The author declares no conflict of interest.
| 1. | Berliner D, Hänselmann A, Bauersachs J: The treatment of heart failure with reduced ejection fraction. Dtsch Arztebl Int 2020; 117: 376–86 VOLLTEXT |
| 2. | Mullens W, Damman K, Harjola V-P, et al.: The use of diuretics in heart failure with congestion—a position statement from the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2019; 21: 137–55 CrossRef CrossRef |
| 3. | Rossignol P, Hernandez AF, Solomon SD, Zannad F: Heart failure drug treatment. Lancet 2019; 393: 1034–44 CrossRef |
