Damman Kevin, Testani Jeffrey M
University of Groningen, Department of Cardiology, University Medical Center Groningen, Hanzeplein 1, 9700RB Groningen, The Netherlands
Department of Internal Medicine and Program of Applied Translational Research, Yale University, New Haven, CT, USA.
Eur Heart J. 2015 Jun 14;36(23):1437-44. doi: 10.1093/eurheartj/ehv010. Epub 2015 Apr 2.
Heart and kidney are closely related in the clinical syndrome of heart failure (HF). It is now sufficiently clear that renal dysfunction occurs frequently in all phenotypes of HF, and when present, it is associated with higher mortality and morbidity. While the pathophysiology is multifactorial, the most important factors are a reduced renal perfusion and venous congestion. Recent interest has focused on worsening renal function (WRF), a situation strongly related to mortality, but seemingly only when HF status deteriorates. Unfortunately, to date clinicians are unable to identify specifically those patients with a grim prognosis following WRF. Although much has been learned on cardiorenal interaction in HF, still more questions have been left unanswered. The coming decade should provide us with more dedicated epidemiologic, mechanistic, and controlled trials in HF patients with reduced renal function. An updated classification of the cardiorenal syndrome that incorporates recent evidence and points towards areas of interest and uncertainties, and areas where progress is needed could facilitate this process. Ultimately, this should lead to preventive and treatment strategies that can preserve renal function and associated outcome in patients with HF.
在心力衰竭（HF）临床综合征中，心脏与肾脏密切相关。目前已经足够明确的是，肾功能不全在HF的所有表型中都频繁发生，并且一旦出现，就与更高的死亡率和发病率相关。虽然病理生理学是多因素的，但最重要的因素是肾灌注减少和静脉淤血。最近的研究兴趣集中在肾功能恶化（WRF）上，这种情况与死亡率密切相关，但似乎仅在HF病情恶化时出现。不幸的是，迄今为止临床医生无法特异性识别那些WRF后预后不良的患者。尽管在HF的心肾相互作用方面已经有了很多了解，但仍有更多问题未得到解答。未来十年应该为我们提供更多针对肾功能减退的HF患者的专门流行病学、机制和对照试验。一个纳入最新证据、指出感兴趣和不确定领域以及需要取得进展领域的更新的心肾综合征分类可能会促进这一进程。最终，这应该会带来能够保护HF患者肾功能及相关预后的预防和治疗策略。
