Kidney and Hypertension Section, E P Joslin Research Laboratory, Joslin Diabetes Center, Boston, MA 02215, USA.
Division of Organ Transplantation, Rhode Island Hospital, Providence, RI 02903, USA.
Int J Mol Sci. 2022 Jul 1;23(13):7351. doi: 10.3390/ijms23137351.
The end-stage of the clinical combination of heart failure and kidney disease has become known as cardiorenal syndrome. Adverse consequences related to diabetes, hyperlipidemia, obesity, hypertension and renal impairment on cardiovascular function, morbidity and mortality are well known. Guidelines for the treatment of these risk factors have led to the improved prognosis of patients with coronary artery disease and reduced ejection fraction. Heart failure hospital admissions and readmission often occur, however, in the presence of metabolic, renal dysfunction and relatively preserved systolic function. In this domain, few advances have been described. Diabetes, kidney and cardiac dysfunction act synergistically to magnify healthcare costs. Current therapy relies on improving hemodynamic factors destructive to both the heart and kidney. We consider that additional hemodynamic solutions may be limited without the use of animal models focusing on the cardiomyocyte, nephron and extracellular matrices. We review herein potential common pathophysiologic targets for treatment to prevent and ameliorate this syndrome.
心力衰竭和肾脏疾病的临床终末期已被称为心肾综合征。众所周知，糖尿病、高血脂、肥胖、高血压和肾功能损害对心血管功能、发病率和死亡率都有不良影响。针对这些危险因素的治疗指南已经改善了冠心病和射血分数降低患者的预后。然而，心力衰竭患者经常因代谢、肾功能障碍和相对保留的收缩功能而住院和再次入院。在这一领域，描述的进展很少。糖尿病、肾脏和心脏功能障碍协同作用，增加了医疗保健成本。目前的治疗依赖于改善对心脏和肾脏都有破坏性的血流动力学因素。我们认为，如果不使用关注心肌细胞、肾单位和细胞外基质的动物模型，额外的血流动力学解决方案可能会受到限制。我们在此回顾了预防和改善这种综合征的潜在共同病理生理治疗靶点。
