1. Juan A. Alicea Rolón

    I have been treating patients with severe chronic combined systolic and diastolic heart failure for years with combined diuretics, loop diuretics and aldosterone antagonists ( metolazone , furosemide and spironolactone ) with great response to this therapy in patients with and without CKD STAGE 1 to 4 , both groups have excellent responses to the therapy, clinically documented improvement in dyspnea , legs edema and largely improve diuresis and lost weight without worsening renal function , dyspnea is resolved as high as 90% of the cases but overall 100% have some significant improvement, nevertheless those with worse renal dysfunction stage 5 improved in their dyspnea but do not resolve edema significantly! Always f/u is one week first then every 8 weeks until fully stabilized! Doses of Metolazone 2.5 to 5 mg , Furosemide 20 mg and Spironolactone 25 mg , all in a twice daily dose.


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