Patel V, Zameer R, Kumar B, Das M. Adjunctive pharmacologic therapies for diuretic resistance in acute decompensated heart failure: Systematic review of randomized trials. World J Meta-Anal 2026; 14(1): 118496 [DOI: 10.13105/wjma.v14.i1.118496]
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07768353
Submitted on:
March 11, 2026, 13:06
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Reader Comments:
This systematic review of 8 randomized trials (1758 participants) rigorously evaluates adjunctive pharmacotherapies for diuretic resistance in acute decompensated heart failure (ADHF), adhering to PRISMA guidelines and using Cochrane’s RoB 2.0 for bias assessment. Key findings show proximal nephron-targeted agents (acetazolamide, SGLT2 inhibitors) and distal thiazide diuretics effectively boost decongestion: acetazolamide raises successful decongestion rates (42.2% vs 30.5%), SGLT2 inhibitors enhance urine output and reduce worsening HF, while thiazides prompt greater weight loss but increase renal dysfunction risk. Notably, older agents (high-dose spironolactone, low-dose dopamine/nesiritide) yield no meaningful clinical benefits. The review’s strength lies in its exclusive focus on randomized trials, but heterogeneity in endpoints and short follow-up limit generalizability. It provides a mechanistically guided, stepwise clinical framework for ADHF management, emphasizing personalized adjunct selection, and identifies the need for large head-to-head trials and long-term outcome research to address existing evidence gaps.