Diuretic-associated sarcopenia in patients with chronic heart failure: a new clinical and organizational problem

Chronic heart failure (CHF) remains one of the leading causes of hospitalization, disability, and mortality among older patients. In this context, sarcopenia is becoming increasingly important, as it is associated with reduced physical functioning, impaired quality of life, and an unfavorable prognosis. The aim of this review was to analyze current evidence on the impact of long-term diuretic therapy, disturbances of sodium and osmotic homeostasis, and the phenomenon of metabolic aestivation on the development of sarcopenia in patients with CHF. The review was conducted in accordance with PRISMA recommendations; the literature search was performed in PubMed, Scopus, eLIBRARY.ru, Google Scholar, WHO IRIS, and other scientific resources. Current evidence suggests that long-term diuretic therapy, osmotic stress, activation of protein catabolism, and increased urea production may be involved in the pathogenesis of sarcopenia. Diuretic-associated sarcopenia has both clinical and organizational significance, as it is associated with increased hospitalization rates, functional dependence, and healthcare costs, supporting the need for sarcopenia screening in patients with CHF receiving long-term diuretic therapy.