Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (R.B.P., S.J.S.).
Department of Cardiology, University of Groningen, University Medical Centre, the Netherlands (J.M.T.M.).
Circulation. 2021 Mar 2;143(9):949-958. doi: 10.1161/CIRCULATIONAHA.120.049514. Epub 2021 Jan 7.
Patients with chronic cardiovascular or metabolic diseases, including diabetes, hypertension, obesity, and heart failure, often have comorbid kidney disease. Long-term outcomes are worse in the setting of both cardiac and kidney disease compared with either disease in isolation. In addition, the clinical presentations of certain acute cardiovascular events (such as heart failure) and worsening kidney function overlap and may be challenging to distinguish. Recently, certain novel treatments have demonstrated beneficial effects on both cardiac and kidney outcomes. Sodium-glucose cotransporter-2 inhibitors have exhibited concordant risk reduction and clinically important benefits in chronic kidney disease with and without diabetes, diabetes and established cardiovascular disease or multiple atherosclerotic vascular disease risk factors, and heart failure with reduced ejection fraction with and without diabetes. Primary trial results have revealed that sacubitril-valsartan therapy improves cardiovascular outcomes in patients with chronic heart failure with reduced ejection fraction and post hoc analyses suggest favorable kidney effects. A concordant pattern of kidney benefit with sacubitril-valsartan has also been observed in chronic heart failure with preserved ejection fraction. Given the complex interplay between cardiac and kidney disease and the possibility that treatments may show concordant cardio-kidney benefits, there has been recent interest in formally acknowledging, defining, and using composite cardio-kidney outcomes in future cardiovascular trials. This review describes potential challenges in use of such outcomes that should be considered and addressed before their incorporation into such trials.
患有慢性心血管或代谢疾病（包括糖尿病、高血压、肥胖症和心力衰竭）的患者常合并肾脏疾病。与孤立性心脏或肾脏疾病相比，同时患有心脏和肾脏疾病的患者长期预后更差。此外，某些急性心血管事件（如心力衰竭）的临床表现与肾功能恶化重叠，可能难以区分。最近，某些新型治疗方法对心脏和肾脏结局均显示出有益作用。钠-葡萄糖共转运蛋白-2 抑制剂在合并或不合并糖尿病、糖尿病合并已确诊的心血管疾病或多种动脉粥样硬化性血管疾病危险因素以及合并或不合并糖尿病的心衰射血分数降低患者中表现出一致的降低风险和具有临床重要意义的获益。主要试验结果表明，沙库巴曲缬沙坦治疗可改善射血分数降低的慢性心力衰竭患者的心血管结局，且事后分析提示其对肾脏有获益作用。在射血分数保留的心力衰竭患者中也观察到沙库巴曲缬沙坦具有一致的肾脏获益模式。鉴于心脏和肾脏疾病之间的复杂相互作用，以及治疗方法可能具有一致的心脏-肾脏获益作用，最近人们对在未来心血管试验中正式承认、定义和使用复合心脏-肾脏结局产生了兴趣。本文描述了在将这些结局纳入此类试验之前应考虑和解决的使用此类结局的潜在挑战。
