Zhu Xiaogang, Li Xialing, Zhu Lingxuan, Tong Zichuan, Xu Xiuying
Department of Cardiology, Fu Xing Hospital, Capital Medical University, Beijing, China.
School of Data Science, The Chinese University of Hong Kong, Shenzhen, China.
Cardiovasc Ther. 2024 Nov 4;2024:6231184. doi: 10.1155/2024/6231184. eCollection 2024.
Heart failure (HF) and renal dysfunction often coexist and interact in many complex and bidirectional pathways, leading to detrimental effects on patient outcomes. The treatment of HF patients with renal dysfunction presents a significant clinical challenge. Interestingly, sacubitril/valsartan, an angiotensin receptor-neprilysin inhibitor (ARNI), may have beneficial effects on cardiac and renal outcomes in patients with HF with reduced ejection fraction, particularly by slowing the rate of decrease in the estimated glomerular filtration rate compared to a single angiotensin-converting enzyme inhibitor. Recently, more reports have emphasized the renal protection of sacubitril/valsartan in patients with HF. In HF patients with renal dysfunction, however, there is no strong evidence supporting the use of sacubitril/valsartan to reduce the absolute risk of hyperkalemia and worsening renal function; therefore, the administration of ARNI requires a careful balance between the benefits and risks. Furthermore, the lack of evidence-based management highlights the importance of an individualized approach based on published experience and multidisciplinary collaborations, as well as underlines the need for in-depth studies investigating the underlying mechanisms in cardiorenal interactions with a focus on treatments.
心力衰竭（HF）与肾功能不全常同时存在，并在许多复杂的双向途径中相互作用，对患者的预后产生不利影响。治疗合并肾功能不全的HF患者是一项重大的临床挑战。有趣的是，沙库巴曲缬沙坦，一种血管紧张素受体脑啡肽酶抑制剂（ARNI），可能对射血分数降低的HF患者的心脏和肾脏预后产生有益影响，特别是与单一血管紧张素转换酶抑制剂相比，它能减缓估计肾小球滤过率的下降速度。最近，更多报告强调了沙库巴曲缬沙坦对HF患者的肾脏保护作用。然而，在合并肾功能不全的HF患者中，没有强有力的证据支持使用沙库巴曲缬沙坦来降低高钾血症和肾功能恶化的绝对风险；因此，ARNI的给药需要在获益和风险之间仔细权衡。此外，缺乏循证管理凸显了基于已发表经验和多学科合作的个体化方法的重要性，同时也强调了深入研究心脏-肾脏相互作用潜在机制（重点是治疗方法）的必要性。
