Shweta Bansal, M.D.

Cardiac patients who are not responding to conventional treatment for fluid overload can be aided with higher doses of the diuretic spironolactone — potentially averting the need for dialysis, investigators have found.

Diuretics and a low-salt diet are standard therapy for excessive fluid retention in heart failure patients. But up to 20% of patients don’t respond to these treatments, and may remain unable to walk or lie flat. 

“They are miserable because of shortness of breath and distension in their abdomen and legs,” explained Shweta Bansal, M.D., of UT Health San Antonio.

Resistance to commonly used diuretics is often due to their effect on kidney function, Bansal reported. But spironolactone’s composition allows it to circumvent the problem. Bansal and colleagues increased the dosage of this drug from the usual 25-to-50 milligrams to 100 and 200 milligrams to prompt improvement in diuretic-resistant patients.

The results — a significant increase in urine output and improvement in shortness of breath among study participants — shows dramatic potential for this treatment, Bansal said in a statement. “We think some patients could avoid needing dialysis if treated in this manner.”

The study was published in the July issue of Annals of Internal Medicine.