Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.
Department of Renal Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK.
Br J Hosp Med (Lond). 2024 Apr 30;85(4):1-10. doi: 10.12968/hmed.2023.0452.
There is a significant burden of cardiovascular disease morbidity and mortality in the end-stage kidney disease population, driven by traditional and non-traditional risk factors. Despite its prevalence, heart failure is difficult to diagnose in the dialysis population due to overlapping clinical presentations, limitations of investigations, and the impact on the cardiorenal axis. 'Foundation therapies' are the key medications which improve patient outcomes in heart failure with reduced ejection fraction and include beta-blockers, renin-angiotensin-aldosterone system inhibitors and sodium-glucose cotransporter-2 inhibitors. They are underutilised in the dialysis population due to the exclusion of chronic kidney disease patients from major trials and legitimate clinical concerns e.g. hyperkalaemia, intradialytic hypotension and residual kidney function preservation. A coordinated cardiorenal multidisciplinary approach can guide appropriate diagnostic considerations (biomarkers interpretation, imaging, addressing unique complications of kidney disease), optimise dialysis management (prescription length, frequency and ultrafiltration targets) and when at euvolaemia facilitate the stepwise introduction of appropriate foundation therapies.
终末期肾病患者存在心血管疾病发病率和死亡率的巨大负担，这是由传统和非传统危险因素驱动的。尽管心力衰竭很常见，但由于临床表现重叠、检查的局限性以及对心肾轴的影响，在透析人群中很难诊断。“基础治疗”是改善射血分数降低的心力衰竭患者预后的关键药物，包括β受体阻滞剂、肾素-血管紧张素-醛固酮系统抑制剂和钠-葡萄糖共转运蛋白 2 抑制剂。由于慢性肾脏病患者被排除在主要试验之外，以及存在合理的临床问题，如高钾血症、透析中低血压和残余肾功能保护，这些药物在透析人群中的应用不足。协调的心肾多学科方法可以指导适当的诊断考虑（生物标志物解释、影像学检查、解决肾脏病的独特并发症），优化透析管理（处方长度、频率和超滤目标），并在血容量正常时逐步引入适当的基础治疗。
