Co-Administration of Albumin and Furosemide in Acute Heart Failure with Diuretic Resistance


  • Jorge Fernandes Clínica de Insuficiência Cardíaca. Serviço de Medicina III. Hospital de São Francisco Xavier. Centro Hospitalar de Lisboa Ocidental. Lisboa.
  • Rita Costa Serviço de Medicina Interna. Centro Hospitalar de Vila Nova de Gaia/Espinho. Vila Nova de Gaia.
  • Renato Guerreiro Serviço de Medicina Interna. Hospital de São Francisco Xavier. Centro Hospitalar de Lisboa Ocidental. Lisboa.
  • Dulce Bonifácio Serviço de Medicina Interna. Hospital Distrital de Torres Vedras. Centro Hospitalar do Oeste. Torres Vedras.
  • Ana Rodrigues Serviço de Medicina Interna. Unidade Local de Saúde do Norte Alentejano. Hospital Santa Luzia de Elvas. Elvas.
  • Célia Henriques Clínica de Insuficiência Cardíaca. Serviço de Medicina III. Hospital de São Francisco Xavier. Centro Hospitalar de Lisboa Ocidental. Lisboa; NOVA Medical School. Faculdade de Ciências Médicas. Universidade Nova de Lisboa. Lisboa.
  • Patrícia Branco NOVA Medical School. Faculdade de Ciências Médicas. Universidade Nova de Lisboa. Lisboa; Serviço de Nefrologia. Hospital de Santa Cruz. Centro Hospitalar de Lisboa Ocidental. Lisboa.
  • Inês Araújo Clínica de Insuficiência Cardíaca. Serviço de Medicina III. Hospital de São Francisco Xavier. Centro Hospitalar de Lisboa Ocidental. Lisboa; NOVA Medical School. Faculdade de Ciências Médicas. Universidade Nova de Lisboa. Lisboa.
  • Cândida Fonseca Clínica de Insuficiência Cardíaca. Serviço de Medicina III. Hospital de São Francisco Xavier. Centro Hospitalar de Lisboa Ocidental. Lisboa; NOVA Medical School. Faculdade de Ciências Médicas. Universidade Nova de Lisboa. Lisboa.



Albumins, Diuretics, Drug Resistance, Furosemide, Heart Failure, Sodium Potassium Chloride Symporter Inhibitors


Acute heart failure is a frequent cause of hospital admission in Portugal, and has an increasing tendency given the aging population. Although most admissions for acute heart failure are caused by congestive conditions, not all patients have a congestive phenotype, reflecting the complexity of a process with multiple pathophysiological pathways. The use of diuretics, usually loop diuretics, is the mainstay of treatment for congestion. However, many patients develop resistance, thus constituting a challenge with no consensual solution to date, despite extensive debate over the years. Despite its frequent use in clinical practice, the co-administration of albumin and furosemide remains controversial in the management of patients with acute heart failure, hypoalbuminemia, and diuretic resistance. This review addresses the pathophysiological mechanisms of congestion in patients with acute heart failure and explores the theoretical basis that supports the co-administration of albumin and furosemide in this clinical context. It is intended to clarify the potential benefit of the combined approach in this specific population and identify possible gaps in the literature that could be the subject of future studies.


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How to Cite

Fernandes J, Costa R, Guerreiro R, Bonifácio D, Rodrigues A, Henriques C, Branco P, Araújo I, Fonseca C. Co-Administration of Albumin and Furosemide in Acute Heart Failure with Diuretic Resistance. Acta Med Port [Internet]. 2023 Feb. 10 [cited 2023 Mar. 30];36(3):193-201. Available from:



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