Kazory Amir
Amir Kazory, Division of Nephrology, Hypertension and Renal Transplantation, College of Medicine, University of Florida, Gainesville, FL 32610-0224, United States.
World J Nephrol. 2017 Jul 6;6(4):168-175. doi: 10.5527/wjn.v6.i4.168.
Congestion is an integral component of cardiorenal syndrome and portends an adverse impact on the outcomes. Recent studies suggest that congestion has the ability of modulating the interactions between the kidney and the heart in this setting. Peritoneal dialysis (PD) is a home-based therapeutic modality that is not only offered to patients with end-stage renal disease to provide solute clearance and ultrafiltration, but it has also been used in patients with refractory heart failure and fluid overload to help optimize volume status. Several uncontrolled studies and case series have so far evaluated the role of PD in management of hypervolemia for patients with heart failure. They have generally reported favorable results in this setting. However, the data on the outcomes of patients with end-stage renal disease and concomitant heart failure is mixed, and the proposed theoretical advantages of PD might not translate into improved clinical endpoints. Congestion is prevalent in this patient population and has a significant effect on their survival. As studies suggest that a significant subset of patients with end-stage renal disease who receive PD therapy are hypervolemic, suboptimal management of congestion could at least in part explain these conflicting results. PD is a highly flexible therapeutic modality and the choice of techniques, regimens, and solutions can affect its ability for optimization of fluid status. This article provides an overview of the currently available data on the role and clinical relevance of congestion in patients with cardiorenal syndrome and reviews potential options to enhance decongestion in these patients.
充血是心肾综合征的一个重要组成部分，预示着对预后有不利影响。最近的研究表明，在这种情况下，充血能够调节肾脏与心脏之间的相互作用。腹膜透析（PD）是一种居家治疗方式，不仅用于终末期肾病患者以实现溶质清除和超滤，还用于难治性心力衰竭和液体超负荷患者以帮助优化容量状态。迄今为止，一些非对照研究和病例系列评估了PD在心力衰竭患者高血容量管理中的作用。他们通常报告在这种情况下有良好的结果。然而，关于终末期肾病合并心力衰竭患者预后的数据并不一致，PD所提出的理论优势可能无法转化为改善的临床终点。充血在这一患者群体中普遍存在，对其生存有显著影响。由于研究表明，接受PD治疗的终末期肾病患者中有相当一部分存在高血容量，充血管理欠佳至少可以部分解释这些相互矛盾的结果。PD是一种高度灵活的治疗方式，技术、方案和溶液的选择会影响其优化液体状态的能力。本文概述了目前关于充血在心肾综合征患者中的作用和临床相关性的可用数据，并综述了增强这些患者去充血的潜在选择。
