Waldum-Grevbo Bård
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
Cardiology. 2015;131(2):130-8. doi: 10.1159/000381012. Epub 2015 May 6.
The majority of outpatients with heart failure (HF) have chronic kidney disease (CKD) as an important comorbidity. Both glomerular filtration rate and abnormal urinary albumin excretion are major predictors of outcome in HF patients. Despite this, patients with renal dysfunction have been systematically excluded from the large randomized HF trials. There is lack of evidence for optimal treatment in these cardiorenal patients and treatment nihilism may account in part for their bad prognosis. Identifying and monitoring the progression of renal disease and making an effort to preserve renal function should be an important task in the management of all patients with HF. In this review, the current understanding of the pathophysiology of renal dysfunction in outpatients with HF will be summarized. Furthermore, important principles of the identification and management of cardiorenal patients will be described in order to make the physician more capable of managing outpatients with HF and renal dysfunction.
大多数心力衰竭（HF）门诊患者合并有慢性肾脏病（CKD）这一重要合并症。肾小球滤过率和尿白蛋白排泄异常都是HF患者预后的主要预测指标。尽管如此，肾功能不全患者在大型随机HF试验中被系统性排除。目前缺乏针对这些心肾疾病患者的最佳治疗证据，治疗虚无主义可能在一定程度上导致了他们的不良预后。识别和监测肾脏疾病的进展并努力保护肾功能，应是所有HF患者管理中的一项重要任务。在本综述中，将总结目前对HF门诊患者肾功能不全病理生理学的认识。此外，还将描述心肾疾病患者识别和管理的重要原则，以使医生更有能力管理HF和肾功能不全的门诊患者。
