Xanthopoulos Andrew, Papamichail Adamantia, Briasoulis Alexandros, Loritis Konstantinos, Bourazana Angeliki, Magouliotis Dimitrios E, Sarafidis Pantelis, Stefanidis Ioannis, Skoularigis John, Triposkiadis Filippos
Department of Cardiology, University Hospital of Larissa, 41110 Larissa, Greece.
Amyloidosis Center, Department of Clinical Therapeutics, Faculty of Medicine, Alexandra Hospital, National and Kapodistrian University of Athens, 15772 Athens, Greece.
J Clin Med. 2023 Sep 21;12(18):6105. doi: 10.3390/jcm12186105.
The function of the kidney is tightly linked to the function of the heart. Dysfunction/disease of the kidney may initiate, accentuate, or precipitate of the cardiac dysfunction/disease and vice versa, contributing to a negative spiral. Further, the reciprocal association between the heart and the kidney may occur on top of other entities, usually diabetes, hypertension, and atherosclerosis, simultaneously affecting the two organs. Chronic kidney disease (CKD) can influence cardiac function through altered hemodynamics and salt and water retention, leading to venous congestion and therefore, not surprisingly, to heart failure (HF). Management of HF in CKD is challenging due to several factors, including complex interplays between these two conditions, the effect of kidney dysfunction on the metabolism of HF medications, the effect of HF medications on kidney function, and the high risk for anemia and hyperkalemia. As a result, in most HF trials, patients with severe renal impairment (i.e., eGFR 30 mL/min/1.73 m or less) are excluded. The present review discusses the epidemiology, pathophysiology, and current medical management in patients with HF developing in the context of CKD.
肾脏的功能与心脏的功能紧密相连。肾脏功能障碍/疾病可能引发、加重或促成心脏功能障碍/疾病，反之亦然，从而形成恶性循环。此外，心脏与肾脏之间的相互关联可能叠加在其他病症之上，通常是糖尿病、高血压和动脉粥样硬化，同时影响这两个器官。慢性肾脏病（CKD）可通过改变血液动力学以及水钠潴留影响心脏功能，导致静脉淤血，因此，毫不奇怪，会引发心力衰竭（HF）。由于多种因素，包括这两种病症之间的复杂相互作用、肾脏功能障碍对HF药物代谢的影响、HF药物对肾功能的影响以及贫血和高钾血症的高风险，CKD患者的HF管理具有挑战性。因此，在大多数HF试验中，严重肾功能损害（即估算肾小球滤过率[eGFR]为30毫升/分钟/1.73平方米或更低）的患者被排除在外。本综述讨论了在CKD背景下发生HF的患者的流行病学、病理生理学和当前的药物治疗。
