Additionally, adenosine may mediate diuretic resistance; it acts on renal A1-AR on afferent arterioles to reduce glomerular flow and filtration, stimulate renin release, and enhance proximal tubular sodium reabsorption.29 It could be postulated that cross-activation of renal AR promoted fluid retention, increased LV volumes and advanced heart failure pathophysiology in our adenosine-treated cohort. Here, REN is linked to advanced heart failure.