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Article

Sodium and water retention in heart failure and diuretic therapy: Basic mechanisms

Gary Francis, MD and Domenic A. Sica, MD
Cleveland Clinic Journal of Medicine June 2006, 73 (6 suppl 2) S2-S7;
Gary Francis
Cleveland Clinic
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Domenic A. Sica
Section of Clinical Pharmacology and Hypertension, Division of Nephrology, Virginia Commonwealth University Health System, Richmond, VA
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ABSTRACT

The pathophysiology of sodium and water retention in heart failure is characterized by a complex interplay of hemodynamic and neurohumoral factors. Relative arterial underfilling is an important signal that triggers heart failure-related sodium and water retention. The response to perceived arterial underfilling is modulated by the level of neurohormonal activation, the degree of renal vasoconstriction, and the extent to which renal perfusion pressure is reduced. Sodium retention can also be exceeded by water retention, with the result being dilutional hyponatremia. Sodium and water retention in heart failure also function to dampen the natriuretic response to diuretic therapy. The attenuated response to diuretics in heart failure is both disease-specific and separately influenced by the rate and extent of diuretic absorption, the rapidity of diuretic tubular delivery, and diuretic-related hypertrophic structural changes that surface in the distal tubule.

Footnotes

  • ↵* Dr. Sica reported that he has no financial relationships that pose a potential conflict of interest with this article.

  • © 2006 The Cleveland Clinic Foundation. All Rights Reserved.
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Cleveland Clinic Journal of Medicine: 73 (6 suppl 2)
Cleveland Clinic Journal of Medicine
Vol. 73, Issue 6 suppl 2
1 Jun 2006
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Sodium and water retention in heart failure and diuretic therapy: Basic mechanisms
Gary Francis, Domenic A. Sica
Cleveland Clinic Journal of Medicine Jun 2006, 73 (6 suppl 2) S2-S7;

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Sodium and water retention in heart failure and diuretic therapy: Basic mechanisms
Gary Francis, Domenic A. Sica
Cleveland Clinic Journal of Medicine Jun 2006, 73 (6 suppl 2) S2-S7;
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