Giamouzis Gregory, Kalogeropoulos Andreas P, Butler Javed, Karayannis Georgios, Georgiopoulou Vasiliki V, Skoularigis John, Triposkiadis Filippos
Heart Failure Unit, Cardiology Department, Larissa University Hospital, P.O. Box 1425, 411 10, Larissa, Greece,
Curr Heart Fail Rep. 2013 Dec;10(4):411-20. doi: 10.1007/s11897-013-0164-6.
Renal dysfunction (RD) is a frequent comorbid condition and a major determinant of outcomes in patients with heart failure (HF). It is likely that the etiology of RD in patients with HF is much more complex than we first thought and represents a matrix of independent, albeit interacting, pathophysiological pathways with effects on both the kidney and the heart that share a common denominator: aging and inflammation. Renal dysfunction in HF has been attributed, among others, to biochemical, hormonal, and hemodynamic factors, coupled with pharmacological interventions. Regardless of the cause, the development of RD or worsening renal function is common in patients with HF, and is associated with increased morbidity and mortality. There is increasing evidence, however, that transient increases in creatinine in the setting of acute HF are not prognostically important, whereas persistent deterioration does portend a higher mortality in this patient population. In addition, congestion seems to play an important role in the course of renal deterioration, and the combination of congestion and worsening renal function is the most significant clinical prognosticator in HF patients. This review aims to provide an update on the epidemiology and prognostic significance of RD in HF patients, in both the acute and the chronic setting.
肾功能不全（RD）是一种常见的合并症，也是心力衰竭（HF）患者预后的主要决定因素。心力衰竭患者肾功能不全的病因可能比我们最初认为的要复杂得多，它代表了一系列独立但相互作用的病理生理途径，这些途径对肾脏和心脏都有影响，其共同特征是衰老和炎症。心力衰竭患者的肾功能不全除其他因素外，还归因于生化、激素和血流动力学因素，以及药物干预。无论病因如何，肾功能不全的发生或肾功能恶化在心力衰竭患者中很常见，并且与发病率和死亡率增加相关。然而，越来越多的证据表明，急性心力衰竭时肌酐的短暂升高在预后方面并不重要，而持续恶化确实预示着该患者群体的死亡率更高。此外，充血似乎在肾脏恶化过程中起重要作用，充血和肾功能恶化的组合是心力衰竭患者最重要的临床预后指标。本综述旨在提供关于急性和慢性心力衰竭患者肾功能不全的流行病学及预后意义的最新信息。
