Diuretic resistance, defined as an inadequate quantity of natriuresis despite an adequate diuretic regimen, is a major clinical challenge that generally portends a poor prognosis. In this review, we discuss the fundamental mechanisms and physiologic principles that underlie the use of diuretic therapy and the available data on the optimal use of diuretics.

Editors

Editor-in-Chief
Valentin Fuster, MD, PhD, MACC

CME Editor
Ragavendra R. Baliga, MD

Authors
G. Michael Felker, MD, MHS

Zachary L. Cox, PHARMD

Jeffrey M. Testani, MD, MTR

CME Information

Target Audience

JACC Journal CME/MOC/ECME is intended for physicians who treat patients with cardiovascular disease.

Important Dates

Date of Release: March 9, 2020
Term of Approval/Date of CME/MOC/ECME Expiration: March 8, 2021

Learner Objectives

After reading this article the reader should be able to:

• Discuss the role of loop diuretic pharmacokinetics and pharmacodynamics in the response to loop diuretics in heart failure.
• Describe the pathophysiology of diuretic resistance in heart failure and available treatment approaches.
• Explain the best approaches for optimizing chronic oral diuretic therapy in heart failure.

Method of Participation and Claiming Credit
This ACC JACC Journals CME/MOC/ECME activity includes the reading of an article published in one of the JACC journals and the successful completion of self-assessment questions.  

Requesting AMA PRA Category 1 CME Credit™ and/or MOC, or ECME credit for this Activity
To request credit, you must:

1. Read the article for which you wish to receive credit.
2. Answer the self-assessment questions. You need to have achieved a passing score of 70% or better in order for the Evaluation link to become activated. If you did not achieve a passing score, please click on the Posttest link in the left navigation bar and retake the exam.
3. After you complete the Evaluation, click on the Claim Credit button in the left navigation bar.
4. For CME credit, enter the total amount of time you actually spent in the activity in the box provided. Please note that you may only claim once for this activity. Click Claim.
5. For MOC credit, click the Claim button in the row for MOC. Please note that you may only claim once for this activity. Confirm your ABIM number and date of birth.
6. For ECME credit, click the Claim button in the row for EMCE. Please note that you may only claim once for this activity. Enter date of birth and click Submit.
7. The page will be updated with the date and time that you claimed your credit.
8. To view your credit, or to print a certificate, please go to ACC.org and navigate to the My Transcript section of My ACC.

This CME/MOC/ECME-certified activity may contain links to other educational resources such as clinical trial summaries, journal articles, guidelines, etc., that may not be CME/MOC/ECME certified. Please note that clicking on the links provided to view these resources will open new windows, which are outside of this CME/MOC/ECME-certified activity.