Bauersachs Johann, Kato Eri Toda, Rangaswami Janani
Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
Department of Cardiovascular Medicine and Institute for Advancement of Clinical and Translational Science, Kyoto University Hospital, Kyoto, Japan.
ESC Heart Fail. 2025 Jun 18. doi: 10.1002/ehf2.15345.
Chronic kidney disease (CKD) and chronic heart failure (HF) frequently coexist and, when comorbid, are associated with poorer outcomes. These two diseases have common risk factors, such as diabetes, obesity and hypertension, and common pathophysiological connected mechanisms, including inflammation, endothelial dysfunction, neurohormonal activation and fibrosis. Early diagnosis and intervention are important to slow CKD progression and reduce HF events. Shared therapeutic targets for CKD and HF include the renin-angiotensin system (RAS), sodium-glucose cotransporter 2 (SGLT2), mineralocorticoid receptor (MR) and glucagon-like peptide-1 (GLP-1) receptor. For the management of CKD, current treatment guidelines recommend the use of RAS inhibitors, SGLT2 inhibitors, the nonsteroidal MR antagonist finerenone and GLP-1 receptor agonists. Challenges in the management of patients with CKD and HF include the presence of other comorbidities, leading to polypharmacy. This review highlights gaps and opportunities for improving the management of patients with CKD and chronic HF.
慢性肾脏病（CKD）和慢性心力衰竭（HF）常常并存，合并存在时与更差的预后相关。这两种疾病有共同的危险因素，如糖尿病、肥胖和高血压，以及共同的病理生理关联机制，包括炎症、内皮功能障碍、神经激素激活和纤维化。早期诊断和干预对于减缓CKD进展和减少HF事件很重要。CKD和HF的共同治疗靶点包括肾素-血管紧张素系统（RAS）、钠-葡萄糖协同转运蛋白2（SGLT2）、盐皮质激素受体（MR）和胰高血糖素样肽-1（GLP-1）受体。对于CKD的管理，当前治疗指南推荐使用RAS抑制剂、SGLT2抑制剂、非甾体类MR拮抗剂非奈利酮和GLP-1受体激动剂。CKD和HF患者管理中的挑战包括存在其他合并症，导致用药种类繁多。本综述强调了改善CKD和慢性HF患者管理方面的差距和机遇。
