Publication Name	World Journal of Meta-Analysis
Manuscript ID	118496
Country	Afghanistan

Category	Cardiac & Cardiovascular Systems
Manuscript Type	Systematic Reviews
Article Title	Adjunctive pharmacologic therapies for diuretic resistance in acute decompensated heart failure: Systematic review of randomized trials
Manuscript Source	Unsolicited Manuscript
All Author List	Vaishvik Patel, Rabia Zameer, Beesham Kumar and Mehta Das
Funding Agency and Grant Number
Corresponding Author	Mehta Das, Department of Internal Medicine, Kabul Medical University, Ataturk Road, Jamal Mina, District 3, Kabul 100310, Afghanistan. mehtadas91@gmail.com
Key Words	Acute decompensated heart failure; Diuretic resistance; Adjunctive pharmacologic therapy; Acetazolamide; Thiazide diuretics; Sodium-glucose cotransporter 2 inhibitors; Congestion management; Loop diuretics
Core Tip	Diuretic resistance remains a major obstacle to effective decongestion in acute decompensated heart failure (HF). This systematic review synthesizes randomized controlled trial evidence evaluating adjunctive pharmacologic therapies added to loop diuretics. Therapies targeting proximal tubular sodium handling, particularly acetazolamide, consistently improve decongestion and natriuresis without excess renal risk. Thiazide diuretics, which act at the distal convoluted tubule, enhance diuretic response but increase the risk of renal dysfunction and therefore require cautious use. Sodium-glucose cotransporter 2 inhibitors offer modest diuretic effects, reduce worsening HF events, and provide benefits that are not limited by baseline kidney function. In contrast, older adjuncts such as dopamine, nesiritide, and high-dose spironolactone show no clinical benefit in overcoming acute diuretic resistance.
Citation	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; In press

Received	2026-01-04 08:26
Peer-Review Started	2026-01-04 08:28
First Decision by Editorial Office Director	2026-01-21 07:39
Return for Revision	2026-01-21 15:51
Revised	2026-01-30 13:45
Publication Fee Transferred
Second Decision by Editor	2026-02-24 02:47
Second Decision by Editor-in-Chief
Final Decision by Editorial Office Director	2026-02-24 10:18
Articles in Press	2026-02-24 10:18
Edit the Manuscript by Language Editor
Typeset the Manuscript

ISSN	2308-3840 (online)
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