终末期肾病患者射血分数降低型心力衰竭的医学管理。
Medical Management of Heart Failure With Reduced Ejection Fraction in Patients With Advanced Renal Disease.
机构信息
Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
Department of Medicine, Duke University School of Medicine, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina.
出版信息
JACC Heart Fail. 2019 May;7(5):371-382. doi: 10.1016/j.jchf.2019.02.009.
Abstract
Large randomized clinical trials (RCT) supporting guidelines for the management of heart failure with reduced ejection fraction (HFrEF) have typically excluded patients with advanced chronic kidney disease (CKD). Patients with concomitant advanced CKD and HFrEF experience poor cardiovascular outcomes and mortality relative to either disease in isolation and have been shown to consistently receive lower rates of HFrEF guideline-directed medical therapy (GDMT). This review evaluated recent evidence for the use of GDMT in patients with HFrEF and advanced CKD approaching dialysis from RCTs and observational cohorts. The authors also discuss the limitations and challenges inherent in the evidence for GDMT in this population, and offer guidance to clinicians for proper clinical use and future research directions.
摘要
大型随机临床试验（RCT）支持射血分数降低的心力衰竭（HFrEF）管理指南，通常排除了晚期慢性肾脏病（CKD）患者。同时患有晚期 CKD 和 HFrEF 的患者与单独患有任一疾病相比，心血管结局和死亡率均较差，且一直显示出接受 HFrEF 指南导向的药物治疗（GDMT）的比率较低。这篇综述评估了 RCT 和观察性队列研究中，即将开始透析的 HFrEF 合并晚期 CKD 患者使用 GDMT 的最新证据。作者还讨论了该人群中 GDMT 证据所固有的局限性和挑战，并为临床医生提供了适当的临床应用和未来研究方向的指导。
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