What is the best management strategy for patients with renal failure and volume overload who are unresponsive to loop diuretics?
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Combining loop diuretics with thiazide-type diuretics and continuous infusions of loop diuretics should be tried for patients who are unresponsive to bolus administration of loop diuretics alone. (SOR A, based on guidelines citing homogenous randomized controlled trials.) Other actions that might be considered include fluid restriction, sodium restriction, discontinuing offending medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), ultrafiltration, and hemodialysis. (SOR C, based on expert opinion and disease-oriented outcomes.)
Evidence Based Practice 11(10): 04.