Diuretic response and renal function in heart failure

In patients with heart failure fluid overload is a frequently occurring problem, which is among others caused by an impaired function of the heart. This fluid overload may lead to severe dyspnea warranting an acute hospitalization. The first choice treatment of this fluid overload is administration of water pills. The effect of these pills is that excess water is lost with the urine. The research in this thesis showed that a great number of patients do not respond well to this treatment. A poor response is also associated with higher hospitalization and mortality rates and is therefore a great problem. One of the reasons why these patients do not respond well are renal adaptations. This causes an impaired response as these pills act on the kidney. Several biomarkers in the circulation can help in assessing both renal function and response to these water pills. Our research also showed that clincians can already assess response to treatment 24 hours after starting. Future research will have to show whether (additional) treatment with other medications will improve the response and hopefully also survival of these severely diseased patients