Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
Clin J Am Soc Nephrol. 2013 Oct;8(10):1808-15. doi: 10.2215/CJN.02920313. Epub 2013 Aug 8.
Cardiorenal syndromes (CRSs) with bidirectional heart-kidney signaling are increasingly being recognized for their association with increased morbidity and mortality. In acute CRS, recognition of the importance of worsening kidney function complicating management of acute decompensated heart failure has led to the examination of this specific outcome in the context of acute heart failure clinical trials. In particular, the role of fluid overload and venous congestion has focused interest in the most effective use of diuretic therapy to relieve symptoms of heart failure while at the same time preserving kidney function. Additionally, many novel vasoactive therapies have been studied in recent years with the hopes of augmenting cardiac function, improving symptoms and patient outcomes, while maintaining or improving kidney function. Similarly, recent advances in our understanding of the pathophysiology of chronic CRS have led to reanalysis of kidney outcomes in pivotal trials in chronic congestive heart failure, and newer trials are including changes in kidney function as well as kidney injury biomarkers as prospectively monitored and adjudicated outcomes. This paper provides an overview of some new developments in the pharmacologic management of acute and chronic CRS, examines several reports that illustrate a key management principle for each subtype, and discusses opportunities for future research.
心肾综合征（CRS）具有双向的心脏-肾脏信号传递作用，其与发病率和死亡率的增加密切相关，目前已得到越来越多的认识。在急性 CRS 中，人们认识到肾功能恶化会使急性失代偿性心力衰竭的治疗变得复杂，因此在急性心力衰竭临床试验中对这一特定结局进行了研究。特别是，液体超负荷和静脉充血的作用引起了人们对利尿剂治疗的有效性的关注，以缓解心力衰竭的症状，同时保持肾功能。此外，近年来许多新型血管活性治疗方法也得到了研究，希望增强心脏功能，改善症状和患者预后，同时保持或改善肾功能。同样，近年来我们对慢性 CRS 的病理生理学的认识的进展，导致对慢性充血性心力衰竭关键试验中的肾脏结局进行了重新分析，并且新的试验也将肾功能变化以及肾脏损伤生物标志物作为前瞻性监测和裁决的结局纳入其中。本文概述了急性和慢性 CRS 药物治疗方面的一些新进展，研究了几个说明每种亚型的关键治疗原则的报告，并讨论了未来研究的机会。
