University of Michigan Medical School and Michigan Medicine, Department of Internal Medicine, Division of Cardiovascular Medicine, 1500 East Medical Center Drive, Ann Arbor, Michigan, 48109, USA.
Rev Cardiovasc Med. 2020 Mar 30;21(1):31-39. doi: 10.31083/j.rcm.2020.01.24.
End-stage kidney disease (ESKD) and heart failure (HF) often coexist and must be managed simultaneously. Multidisciplinary collaboration between nephrology and cardiology is critical when treating patients with such complicated physiology. There is no "one-size-fits-all" approach to the evaluation of patients with new left ventricular systolic dysfunction, and diagnostic testing should be adapted to an individual's risk factors. Guideline-directed medical therapy (GDMT) for systolic heart failure should be employed in these patients. While limited randomized data exist, observational data and post hoc analyses suggest that GDMT, including renin angiotensin aldosterone system inhibitors, is associated with improved cardiovascular outcomes and can be safely initiated at low doses with close monitoring of kidney function in this population. Volume status is typically managed through ultrafiltration, so close communication between cardiology and nephrology is necessary to achieve a patient's optimal dry weight and mitigate intradialytic hypotension. Patient education and engagement regarding sodium and fluid restriction is crucial, and symptom burden should be reassessed following changes to the dialysis regimen.
终末期肾病（ESKD）和心力衰竭（HF）常同时存在，必须同时进行治疗。在治疗此类复杂生理状况的患者时，肾脏病学和心脏病学之间的多学科协作至关重要。对于新发左心室收缩功能障碍患者的评估，没有“一刀切”的方法，诊断性检查应根据个体的危险因素进行调整。这些患者应采用指南指导的药物治疗（GDMT）治疗收缩性心力衰竭。虽然随机数据有限，但观察性数据和事后分析表明，GDMT，包括肾素-血管紧张素-醛固酮系统抑制剂，与改善心血管结局相关，并且可以在密切监测肾功能的情况下，以低剂量安全起始该人群的治疗。容量状态通常通过超滤来管理，因此，心脏病学和肾脏病学之间需要密切沟通，以达到患者的最佳干体重，并减轻透析期间低血压。对患者进行钠和液体限制方面的教育和参与至关重要，并且应在透析方案改变后重新评估症状负担。
