Division of Renal Diseases & Hypertension, University of Colorado Denver, Aurora, CO 80045, USA.
Clin J Am Soc Nephrol. 2009 Dec;4(12):2013-26. doi: 10.2215/CJN.03150509. Epub 2009 Nov 19.
Renal dysfunction is highly prevalent in patients with heart failure. Furthermore, worsening renal function in patients with acute decompensated heart failure (ADHF), the so-called cardiorenal syndrome, impacts short and long-term morbidity and mortality. In recent years, more evidence has surfaced from clinical trials and heart failure registries that a complex cross-talk between the kidney and heart in patients with ADHF exists. Meanwhile, management of patients presenting with ADHF and concomitant renal dysfunction continues to be challenging. Therefore, understanding the interaction of the heart and kidneys is pivotal in tailoring therapy of these patients. We have extensively reviewed the pathophysiology of ADHF, the role of neurohoromones as well as other biomarkers and predictors of mortality in these patients based on the current evidence. Moreover, we have discussed the current and future pharmacologic and non-pharmacologic therapies for treatment of this deadly disease. The strength of the evidence is limited, however, due to a paucity of randomized controlled trials in this patient population. What is evident from current national statistics; however, are the poor results in treating the congestion of ADHF. In this regard, the role of secondary hyperaldosteronism is discussed in the diuretic section as well as diuretic resistance in ADHF. In conclusion, since renal function is the single most important prognostic factor in the outcome of patients with ADHF, a better understanding of the pathophysiology of the cardiorenal syndrome is needed to target therapy and ultimately improve the mortality of patients with ADHF.
肾功能障碍在心力衰竭患者中非常普遍。此外，急性失代偿性心力衰竭（ADHF）患者肾功能恶化，即所谓的心肾综合征，会影响短期和长期的发病率和死亡率。近年来，越来越多的临床试验和心力衰竭注册研究表明，ADHF 患者的肾脏和心脏之间存在复杂的相互作用。同时，对伴有肾功能障碍的 ADHF 患者的管理仍然具有挑战性。因此，了解心脏和肾脏之间的相互作用对于这些患者的治疗方案至关重要。我们根据现有证据，对 ADHF 的病理生理学、神经激素的作用以及这些患者的其他生物标志物和死亡率预测因素进行了广泛的回顾。此外，我们还讨论了治疗这种致命疾病的当前和未来的药物和非药物治疗方法。然而，由于在这一患者群体中缺乏随机对照试验，证据的强度有限。然而，从当前的国家统计数据来看，ADHF 充血的治疗效果不佳是显而易见的。在这方面，利尿剂部分讨论了继发性醛固酮增多症在 ADHF 中的作用以及 ADHF 中的利尿剂抵抗。总之，由于肾功能是 ADHF 患者预后的唯一最重要的预后因素，因此需要更好地了解心肾综合征的病理生理学，以靶向治疗并最终降低 ADHF 患者的死亡率。
