Pouchelon J L, Atkins C E, Bussadori C, Oyama M A, Vaden S L, Bonagura J D, Chetboul V, Cowgill L D, Elliot J, Francey T, Grauer G F, Fuentes V Luis, Moise N Sydney, Polzin D J, Van Dongen A M, Van Israël N
Université Paris-Est, Ecole Nationale Vétérinaire d'Alfort, Unité de Cardiologie d'Alfort, Centre Hospitalier Universitaire Vétérinaire d'Alfort (CHUVA), Maisons-Alfort 94704, France.
Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27607, USA.
J Small Anim Pract. 2015 Sep;56(9):537-52. doi: 10.1111/jsap.12387.
There is a growing understanding of the complexity of interplay between renal and cardiovascular systems in both health and disease. The medical profession has adopted the term "cardiorenal syndrome" (CRS) to describe the pathophysiological relationship between the kidney and heart in disease. CRS has yet to be formally defined and described by the veterinary profession and its existence and importance in dogs and cats warrant investigation. The CRS Consensus Group, comprising nine veterinary cardiologists and seven nephrologists from Europe and North America, sought to achieve consensus around the definition, pathophysiology, diagnosis and management of dogs and cats with "cardiovascular-renal disorders" (CvRD). To this end, the Delphi formal methodology for defining/building consensus and defining guidelines was utilised.
Following a literature review, 13 candidate statements regarding CvRD in dogs and cats were tested for consensus, using a modified Delphi method. As a new area of interest, well-designed studies, specific to CRS/CvRD, are lacking, particularly in dogs and cats. Hence, while scientific justification of all the recommendations was sought and used when available, recommendations were largely reliant on theory, expert opinion, small clinical studies and extrapolation from data derived from other species.
Of the 13 statements, 11 achieved consensus and 2 did not. The modified Delphi approach worked well to achieve consensus in an objective manner and to develop initial guidelines for CvRD.
The resultant manuscript describes consensus statements for the definition, classification, diagnosis and management strategies for veterinary patients with CvRD, with an emphasis on the pathological interplay between the two organ systems. By formulating consensus statements regarding CvRD in veterinary medicine, the authors hope to stimulate interest in and advancement of the understanding and management of CvRD in dogs and cats. The use of a formalised method for consensus and guideline development should be considered for other topics in veterinary medicine.
人们越来越认识到肾脏和心血管系统在健康和疾病状态下相互作用的复杂性。医学界采用了“心肾综合征”（CRS）这一术语来描述疾病状态下肾脏与心脏之间的病理生理关系。CRS尚未得到兽医界的正式定义和描述，其在犬猫中的存在及重要性值得研究。由来自欧洲和北美的9名兽医心脏病学家和7名肾病学家组成的CRS共识小组，试图就患有“心血管-肾脏疾病”（CvRD）的犬猫的定义、病理生理学、诊断和管理达成共识。为此，采用了德尔菲正式方法来定义/达成共识并制定指南。
在文献综述之后，使用改良的德尔菲方法对13条关于犬猫CvRD的候选陈述进行了共识测试。作为一个新的研究领域，针对CRS/CvRD的精心设计的研究较为缺乏，尤其是在犬猫中。因此，虽然在可行时寻求并使用了所有建议的科学依据，但建议在很大程度上依赖于理论、专家意见、小型临床研究以及从其他物种数据进行的推断。
13条陈述中，11条达成了共识，2条未达成共识。改良的德尔菲方法有效地以客观方式达成了共识，并为CvRD制定了初步指南。
最终的手稿描述了针对患有CvRD的兽医患者的定义、分类、诊断和管理策略的共识声明，重点强调了两个器官系统之间的病理相互作用。通过制定兽医学中关于CvRD的共识声明，作者希望激发对犬猫CvRD的理解和管理的兴趣并推动其进展。对于兽医学中的其他主题，应考虑使用正式方法来达成共识和制定指南。
