Adamska-Wełnicka Anna, Wełnicki Marcin, Mamcarz Artur, Gellert Ryszard
Clinic of Nephrology and Internal Medicine, Centre of Postgraduate Medical Education, 01-813 Warsaw, Poland.
3rd Department of Internal Medicine and Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland.
Diagnostics (Basel). 2021 Nov 22;11(11):2164. doi: 10.3390/diagnostics11112164.
Is advanced chronic kidney disease (CKD) a cardiac "no man's land"? Chronic heart failure (HF) is widely believed to be one of the most serious medical challenges of the 21st century. Moreover, the number of patients with CKD is increasing. To date, patients with estimated glomerular filtration rates <30 mL/min/1.73 m have frequently been excluded from large, randomized clinical trials. Although this situation is slowly changing, in everyday practice we continue to struggle with problems that are not clearly addressed in the guidelines. This literature review was conducted by an interdisciplinary group, which comprised a nephrologist, internal medicine specialists, and cardiologist. In this review, we discuss the difficulties in ruling out HF for patients with advanced CKD and issues regarding the cardiotoxicity of dialysis fistulas and the occurrence of pulmonary hypertension in patients with CKD. Due to the recent publication of the new HF guidelines by the European Society of Cardiology, this is a good time to address these difficult issues. Contrary to appearances, these are not niche issues, but problems that affect many patients.
晚期慢性肾脏病（CKD）是心脏的“无人区”吗？慢性心力衰竭（HF）被广泛认为是21世纪最严峻的医学挑战之一。此外，CKD患者数量正在增加。迄今为止，估算肾小球滤过率<30 mL/min/1.73 m²的患者常常被排除在大型随机临床试验之外。尽管这种情况正在慢慢改变，但在日常临床实践中，我们仍在为指南中未明确提及的问题而困扰。这篇文献综述由一个跨学科团队完成，团队成员包括一名肾病科医生、内科专家和心脏病专家。在本综述中，我们讨论了在晚期CKD患者中排除HF的困难，以及透析瘘管的心脏毒性和CKD患者发生肺动脉高压的相关问题。鉴于欧洲心脏病学会近期发布了新的HF指南，现在是解决这些难题的好时机。与表面现象相反，这些并非小众问题，而是影响众多患者的问题。
