{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T18:28:58Z","timestamp":1790620138436,"version":"4.1.0"},"reference-count":119,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","funder":[{"name":"National Institutes of Health (NIH)\/National Heart, Lung, and Blood"},{"name":"Institute","award":["R01HL139629,"],"award-info":[{"award-number":["R01HL139629,"]}]},{"name":"Institute","award":["R21HL143092,"],"award-info":[{"award-number":["R21HL143092,"]}]},{"name":"Institute","award":["R01HL128973,"],"award-info":[{"award-number":["R01HL128973,"]}]},{"name":"Institute","award":["R01HL148354,"],"award-info":[{"award-number":["R01HL148354,"]}]},{"name":"Institute","award":["P30DK079310"],"award-info":[{"award-number":["P30DK079310"]}]},{"name":"National"},{"name":"Institute of Diabetes and Digestive and Kidney"},{"name":"Disease","award":["UL1 TR000142"],"award-info":[{"award-number":["UL1 TR000142"]}]},{"name":"National"},{"name":"Center for Advancing Translational Science"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Kidney360"],"published-print":{"date-parts":[[2022,5,26]]},"abstract":"<jats:p>Despite the incompletely understood multiple etiologies and underlying mechanisms, cardiorenal syndrome is characterized by decreased glomerular filtration and sodium avidity. The underlying level of renal sodium avidity is of primary importance in driving a congested heart failure phenotype and ultimately determining the response to diuretic therapy. Historically, mechanisms of kidney sodium avidity and resultant diuretic resistance were primarily extrapolated to cardiorenal syndrome from non\u2013heart failure populations. Yet, the mechanisms appear to differ between these populations. Recent literature in acute decompensated heart failure has refuted several classically accepted diuretic resistance mechanisms and reshaped how we conceptualize diuretic resistance mechanisms in cardiorenal syndrome. Herein, we propose an anatomically based categorization of diuretic resistance mechanisms to establish the relative importance of specific transporters and translate findings toward therapeutic strategies. Within this categorical structure, we discuss classic and novel mechanisms of diuretic resistance.<\/jats:p>","DOI":"10.34067\/kid.0006372021","type":"journal-article","created":{"date-parts":[[2022,3,1]],"date-time":"2022-03-01T17:55:10Z","timestamp":1646157310000},"page":"954-967","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":21,"title":["Classic and Novel Mechanisms of Diuretic Resistance in Cardiorenal Syndrome"],"prefix":"10.34067","volume":"3","author":[{"given":"Zachary L.","family":"Cox","sequence":"first","affiliation":[{"name":"Department of Pharmacy Practice, Lipscomb University College of Pharmacy, Nashville, Tennessee"},{"name":"Department of Pharmacy, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veena S.","family":"Rao","sequence":"additional","affiliation":[{"name":"Division of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5285-0419","authenticated-orcid":false,"given":"Jeffrey M.","family":"Testani","sequence":"additional","affiliation":[{"name":"Division of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2022,5,26]]},"reference":[{"key":"B1-20250825","doi-asserted-by":"crossref","first-page":"e840","DOI":"10.1161\/CIR.0000000000000664","article-title":"Cardiorenal syndrome: Classification, pathophysiology, diagnosis, and treatment strategies: A scientific statement from the American Heart Association","volume":"139","author":"Rangaswami","year":"2019","journal-title":"Circulation"},{"key":"B2-20250825","doi-asserted-by":"crossref","first-page":"1084","DOI":"10.1016\/j.jacc.2020.06.070","article-title":"Contemporary management of severe acute kidney injury and refractory cardiorenal syndrome: JACC Council perspectives","volume":"76","author":"Jentzer","year":"2020","journal-title":"J Am Coll Cardiol"},{"key":"B3-20250825","doi-asserted-by":"crossref","first-page":"2013","DOI":"10.2215\/CJN.03150509","article-title":"Cardiorenal syndrome in acute decompensated heart failure","volume":"4","author":"Sarraf","year":"2009","journal-title":"Clin J Am Soc Nephrol"},{"key":"B4-20250825","doi-asserted-by":"crossref","first-page":"1031","DOI":"10.1016\/j.jacc.2012.01.077","article-title":"Cardiorenal syndrome type 1: Pathophysiological crosstalk leading to combined heart and kidney dysfunction in the setting of acutely decompensated heart failure","volume":"60","author":"Ronco","year":"2012","journal-title":"J Am Coll Cardiol"},{"key":"B5-20250825","doi-asserted-by":"crossref","first-page":"998","DOI":"10.1161\/CIRCULATIONAHA.119.045409","article-title":"Altered hemodynamics and end-organ damage in heart failure: Impact on the lung and kidney","volume":"142","author":"Verbrugge","year":"2020","journal-title":"Circulation"},{"key":"B6-20250825","doi-asserted-by":"crossref","first-page":"2016","DOI":"10.1161\/CIRCULATIONAHA.117.030112","article-title":"Worsening renal function in patients with acute heart failure undergoing aggressive diuresis is not associated with tubular injury","volume":"137","author":"Ahmad","year":"2018","journal-title":"Circulation"},{"key":"B7-20250825","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1002\/ejhf.1642","article-title":"Short-term prognostic implications of serum and urine neutrophil gelatinase-associated lipocalin in acute heart failure: Findings from the AKINESIS study","volume":"22","author":"Wettersten","year":"2020","journal-title":"Eur J Heart Fail"},{"key":"B8-20250825","doi-asserted-by":"crossref","first-page":"1178","DOI":"10.1016\/j.jacc.2019.12.059","article-title":"Diuretic therapy for patients with heart failure: JACC State-of-the-Art Review","volume":"75","author":"Felker","year":"2020","journal-title":"J Am Coll Cardiol"},{"key":"B9-20250825","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1007\/s10741-019-09851-9","article-title":"Loop diuretic resistance complicating acute heart failure","volume":"25","author":"Cox","year":"2020","journal-title":"Heart Fail Rev"},{"key":"B10-20250825","first-page":"450","article-title":"Response of the kidney to furosemide. 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