Lauder L, Ewen S, Emrich I E, Böhm M, Mahfoud F
Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes und Medizinische Fakultät, Universität des Saarlandes, Homburg/Saar, Deutschland.
Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA.
Herz. 2019 Nov;44(7):611-629. doi: 10.1007/s00059-019-04846-6.
There is a close physiological relationship between the kidneys and the heart. Cardiovascular diseases are the most prevalent cause of death in patients with chronic kidney disease (CKD), whereas CKD may directly accelerate the progression of cardiovascular diseases and is considered to be a cardiovascular risk factor. In patients with mild CKD, i.e. an estimated glomerular filtration rate (eGFR) >60 ml/min/1.73 m, treatment of coronary artery disease and chronic heart failure is not essentially different from patients with preserved renal function; however, as most pivotal trials have systematically excluded patients with advanced renal failure, many treatment recommendations in this patient group are based on observational studies, post hoc subgroup analyses and meta-analyses or pathophysiological considerations, which are not supported by controlled studies. Therefore, prospective randomized studies on the management of heart failure and coronary artery disease are needed, which should specifically focus on the growing number of patients with advanced renal functional impairment.
肾脏与心脏之间存在密切的生理关系。心血管疾病是慢性肾脏病（CKD）患者最常见的死亡原因，而CKD可能直接加速心血管疾病的进展，并被认为是一种心血管危险因素。在轻度CKD患者中，即估计肾小球滤过率（eGFR）>60 ml/min/1.73 m²，冠状动脉疾病和慢性心力衰竭的治疗与肾功能正常的患者基本没有差异；然而，由于大多数关键试验系统地排除了晚期肾衰竭患者，该患者群体的许多治疗建议基于观察性研究、事后亚组分析、荟萃分析或病理生理考量，而这些均未得到对照研究的支持。因此，需要开展关于心力衰竭和冠状动脉疾病管理的前瞻性随机研究，尤其应关注肾功能重度受损患者数量的不断增加。
