Koratala Abhilash, Kazory Amir
Division of Nephrology, Hypertension, and Renal Transplantation, University of Florida, Gainesville, FL, USA.
Dis Markers. 2017;2017:1454986. doi: 10.1155/2017/1454986. Epub 2017 Jun 18.
Congestion represents the primary reason for hospitalization of patients with heart failure and is associated with adverse outcomes. Fluid overload has been shown to be inadequately addressed in a significant subset of these patients in part due to lack of robust, reliable, and readily available biomarkers for objective assessment and monitoring of therapy. Natriuretic peptides have long been used in this setting, often in conjunction with other assessment tools such as imaging studies. Patients presenting with concomitant cardiac and renal dysfunction represent a unique population with regard to congestion in that the interactions between the heart and the kidney can affect the utility and performance of biomarkers of fluid overload. Herein, we provide an overview of the currently available evidence on the utility of natriuretic peptides in these patients and discuss the clinical conundrum associated with their use in the setting of renal dysfunction. We highlight the potential divergence in the role of natriuretic peptides for assessment of volume status in a subset of patients with renal dysfunction who receive renal replacement therapy and call for future research to elucidate the utility of the biomarkers in this setting.
充血是心力衰竭患者住院的主要原因，并与不良预后相关。部分此类患者中存在液体超负荷的情况未得到充分解决，这在一定程度上是由于缺乏用于客观评估和监测治疗的强大、可靠且易于获得的生物标志物。利钠肽长期以来一直用于这种情况，通常与其他评估工具（如影像学检查）联合使用。合并心脏和肾功能不全的患者在充血方面代表了一个独特的群体，因为心脏和肾脏之间的相互作用会影响液体超负荷生物标志物的效用和性能。在此，我们概述了目前关于利钠肽在这些患者中的效用的现有证据，并讨论了在肾功能不全情况下使用利钠肽相关的临床难题。我们强调了利钠肽在接受肾脏替代治疗的部分肾功能不全患者中评估容量状态的作用可能存在差异，并呼吁未来开展研究以阐明该生物标志物在这种情况下的效用。
