Renal function monitoring in heart failure - what is the optimal frequency? A narrative review.
Renal function monitoring in heart failure - what is the optimal frequency? A narrative review.
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DOI：
10.1111/bcp.13434
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发表时间：
2018-01
影响因子：
3.4
通讯作者：
Pirmohamed M
中科院分区：
文献类型：
--
作者：
Al-Naher A;Wright D;Devonald MAJ;Pirmohamed M
在英国，由于药物不良反应而住院的第二大常见原因是利尿剂引起的肾功能障碍，特别是在患有心力衰竭的患者中，利尿剂治疗是治疗方案的支柱。因此，监测这些患者肾功能的最佳频率是预防肾功能衰竭和住院治疗的重要考虑因素。本综述根据国家和国际心衰管理指南（AHA/NICE/ESC/SIGN）对心衰患者肾功能最佳监测实践的现有证据进行了研究。目前对肾功能监测的指导在很大程度上是基于专家意见，缺乏专门评估心衰患者肾功能监测最佳频率的临床研究。此外，指南之间存在差异，建议通常是非特异性的。更安全的利尿剂处方联合其他抗心力衰竭治疗需要更好的肾功能监测频率的证据。我们建议开发更个性化的监测，而不是目前基于药物的指导。这种灵活的临床指南可以通过智能临床决策支持系统来实施。个性化的肾功能监测将更有效地预防肾功能下降，而不是对其作出反应。
The second most common cause of hospitalization due to adverse drug reactions in the UK is renal dysfunction due to diuretics, particularly in patients with heart failure, where diuretic therapy is a mainstay of treatment regimens. Therefore, the optimal frequency for monitoring renal function in these patients is an important consideration for preventing renal failure and hospitalization. This review looks at the current evidence for optimal monitoring practices of renal function in patients with heart failure according to national and international guidelines on the management of heart failure (AHA/NICE/ESC/SIGN). Current guidance of renal function monitoring is in large part based on expert opinion, with a lack of clinical studies that have specifically evaluated the optimal frequency of renal function monitoring in patients with heart failure. Furthermore, there is variability between guidelines, and recommendations are typically nonspecific. Safer prescribing of diuretics in combination with other antiheart failure treatments requires better evidence for frequency of renal function monitoring. We suggest developing more personalized monitoring rather than from the current medication‐based guidance. Such flexible clinical guidelines could be implemented using intelligent clinical decision support systems. Personalized renal function monitoring would be more effective in preventing renal decline, rather than reacting to it.
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影响因子：
7.3
作者：
Alexander SP;Kelly E;Marrion N;Peters JA;Benson HE;Faccenda E;Pawson AJ;Sharman JL;Southan C;Davies JA;CGTP Collaborators
通讯作者：
CGTP Collaborators
影响因子：
24
作者：
Damman, Kevin;Tang, W. H. Wilson;McMurray, John J. V.
通讯作者：
McMurray, John J. V.
影响因子：
37.8
作者：
COGAN, JJ;HUMPHREYS, MH;RAPAPORT, E
通讯作者：
RAPAPORT, E
影响因子：
4.8
作者：
Foster, Meredith C.;Rawlings, Andreea M.;Marrett, Elizabeth;Neff, David;Willis, Kerry;Inker, Lesley A.;Coresh, Josef;Selvin, Elizabeth
通讯作者：
Selvin, Elizabeth
影响因子：
4.2
作者：
Anglada-Martinez, Helena;Rovira-Illamola, Marina;Codina-Jane, Carles
通讯作者：
Codina-Jane, Carles