In the past decades impressive progress in heart failure (HF) treatment has been achieved by adoption of therapeutic tools ranging from renin angiotensin system antagonists to beta blocking agents, and resynchronization therapy. None of these therapies was designed to enhance natriuresis and the natriuretic action of loop diuretics remained an irreplaceable tool to counteract fluid overload in acute decompensated HF as well as in chronic HF management. However, in the long run disease progression leads to a need for staging diuretic dose which entails a decline in their effectiveness [1].
