Jarocki Matthew, Green Sophie, Wu Henry H L, Chinnadurai Rajkumar
Department of Renal Medicine, Northern Care Alliance NHS Foundation Trust, Salford M6 8HD, UK.
Renal Research Laboratory, Kolling Institute of Medical Research, Royal North Shore Hospital, The University of Sydney, Sydney, NSW 2065, Australia.
Geriatrics (Basel). 2025 Aug 4;10(4):104. doi: 10.3390/geriatrics10040104.
Cardiorenal syndrome (CRS) is a term used to describe the combined dysfunction of the heart and kidneys. This complex disorder is widely acknowledged to be challenging in both its diagnosis and management, and this is the case particularly in the elderly population, due to multi-morbidity, polypharmacy, and age-related physiological changes. Given advancements in medicine and more prolonged cumulative exposure to risk factors in the elderly population, it is likely that the prevalence of chronic kidney disease (CKD) and heart failure (HF) will continue to rise going forward. Hence, understanding the mechanisms involved in the development of CRS is paramount. There are five different CRS types-they are categorised depending on the primary organ involved the acuity of disease. The pathophysiological process behind CRS is complex, involving the interplay of many processes including hemodynamic changes, neurohormonal activation, inflammation, oxidative stress, and endothelial dysfunction and vascular stiffness. The numerous diagnostic and management challenges associated with CRS are significantly further exacerbated in an elderly population. Biomarkers used to aid the diagnosis of CRS, such as serum creatinine and brain natriuretic peptide (BNP), can be challenging to interpret in the elderly population due to age-related renal senescence and multiple comorbidities. Polypharmacy can contribute to the development of CRS and therefore, before initiating treatment, coordinating a patient-centred, multi-speciality, holistic review to assess potential risks versus benefits of prescribed treatments is crucial. The overall prognosis of CRS in the elderly remains poor. Treatments are primarily directed at addressing the sequelae of the underlying aetiology, which often involves the removal of fluid through diuretics or ultrafiltration. Careful considerations when managing elderly patients with CRS is essential due to the high prevalence of frailty and functional decline. As such, in these patients, early discussions around advance care planning should be prioritised.
心肾综合征（CRS）是一个用于描述心脏和肾脏联合功能障碍的术语。这种复杂的病症在诊断和管理方面都具有挑战性，尤其是在老年人群中，这是由于多种疾病并存、多种药物治疗以及与年龄相关的生理变化所致。鉴于医学的进步以及老年人群中危险因素的累积暴露时间延长，慢性肾脏病（CKD）和心力衰竭（HF）的患病率未来可能会持续上升。因此，了解CRS发生发展的机制至关重要。CRS有五种不同类型，它们根据主要受累器官和疾病的急性程度进行分类。CRS背后的病理生理过程很复杂，涉及许多过程的相互作用，包括血流动力学变化、神经激素激活、炎症、氧化应激以及内皮功能障碍和血管僵硬。与CRS相关的众多诊断和管理挑战在老年人群中会显著加剧。用于辅助CRS诊断的生物标志物，如血清肌酐和脑钠肽（BNP），由于与年龄相关的肾脏衰老和多种合并症，在老年人群中可能难以解释。多种药物治疗可能导致CRS的发生，因此，在开始治疗前，以患者为中心进行多专科、全面的评估，以权衡规定治疗的潜在风险与益处至关重要。老年CRS患者的总体预后仍然很差。治疗主要针对解决潜在病因的后遗症，这通常涉及通过利尿剂或超滤来清除液体。由于衰弱和功能下降的高患病率，在管理老年CRS患者时进行仔细考虑至关重要。因此，对于这些患者，应优先尽早讨论预先护理计划。
