Department of Internal Medicine I, University Hospital Jena, Jena, Germany.
Circ Res. 2023 Apr 14;132(8):1034-1049. doi: 10.1161/CIRCRESAHA.123.321759. Epub 2023 Apr 13.
Chronic kidney disease is associated with an increased risk for the development and progression of cardiovascular disorders including hypertension, dyslipidemia, and coronary artery disease. Chronic kidney disease may also affect the myocardium through complex systemic changes, resulting in structural remodeling such as hypertrophy and fibrosis, as well as impairments in both diastolic and systolic function. These cardiac changes in the setting of chronic kidney disease define a specific cardiomyopathic phenotype known as uremic cardiomyopathy. Cardiac function is tightly linked to its metabolism, and research over the past 3 decades has revealed significant metabolic remodeling in the myocardium during the development of heart failure. Because the concept of uremic cardiomyopathy has only been recognized in recent years, there are limited data on metabolism in the uremic heart. Nonetheless, recent findings suggest overlapping mechanisms with heart failure. This work reviews key features of metabolic remodeling in the failing heart in the general population and extends this to patients with chronic kidney disease. The knowledge of similarities and differences in cardiac metabolism between heart failure and uremic cardiomyopathy may help identify new targets for mechanistic and therapeutic research on uremic cardiomyopathy.
慢性肾脏病与心血管疾病的发生和进展风险增加相关，包括高血压、血脂异常和冠状动脉疾病。慢性肾脏病还可能通过复杂的全身变化影响心肌，导致结构重塑，如肥大和纤维化，以及舒张和收缩功能受损。在慢性肾脏病的背景下，这些心脏变化定义了一种称为尿毒症性心肌病的特定心肌病表型。心脏功能与其代谢紧密相关，过去 30 年的研究揭示了心力衰竭发展过程中心肌中显著的代谢重塑。由于尿毒症性心肌病的概念是近年来才被认识到的，因此在尿毒症心脏中的代谢数据非常有限。尽管如此，最近的发现表明与心力衰竭有重叠的机制。这项工作综述了一般人群中心力衰竭时代谢重塑的关键特征，并将其扩展到慢性肾脏病患者。了解心力衰竭和尿毒症性心肌病中心脏代谢的相似和不同之处，可能有助于确定尿毒症性心肌病的机制和治疗研究的新靶点。
