Evaluation of kidney function throughout the heart failure trajectory - a position statement from the Heart Failure Association of the European Society of Cardiology
Evaluation of kidney function throughout the heart failure trajectory - a position statement from the Heart Failure Association of the European Society of Cardiology
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DOI：
10.1002/ejhf.1697
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发表时间：
2020-01-07
影响因子：
18.2
通讯作者：
Coats, Andrew
中科院分区：
文献类型：
--
作者：
Mullens, Wilfried;Damman, Kevin;Coats, Andrew
在急性和慢性心力衰竭的治疗过程中，对肾功能标志物的变化进行适当的解释是至关重要的。历史上，肾功能主要是通过血清肌酐和估计的肾小球滤过率的计算来评估的。血清肌酐升高，也称为肾功能恶化，通常发生在心力衰竭患者，特别是在急性心力衰竭发作期间。尽管肾功能恶化在人群水平上与更差的结局相关，但在适当的临床背景下对这种变化的解释有助于正确评估风险并确定进一步的治疗策略。此外，越来越多的人认识到，评估肾功能不仅仅是肾小球滤过率。因此，通过更好地评估肾小管对钠和水的处理，可以确定环状利尿剂的效率(环状利尿剂的反应和效率)。此外，尽管神经体液阻滞剂可能导致肾小球滤过率轻度恶化，但它们的使用与改善长期结局有关。因此，更好地了解心肾相互作用在心力衰竭的症状发展、疾病进展和预后中的作用是至关重要的。事实上，也许甚至是对肾功能的误解也是导致急性心力衰竭患者无法缓解充血，以及指南指导的药物治疗剂量不足的主要原因。心力衰竭协会心肾功能不全工作组的这份意见书旨在提高对不同心力衰竭状态下肾功能评估的解释的洞察力，目的是改善心力衰竭的护理。
Appropriate interpretation of changes in markers of kidney function is essential during the treatment of acute and chronic heart failure. Historically, kidney function was primarily assessed by serum creatinine and the calculation of estimated glomerular filtration rate. An increase in serum creatinine, also termed worsening renal function, commonly occurs in patients with heart failure, especially during acute heart failure episodes. Even though worsening renal function is associated with worse outcome on a population level, the interpretation of such changes within the appropriate clinical context helps to correctly assess risk and determine further treatment strategies. Additionally, it is becoming increasingly recognized that assessment of kidney function is more than just glomerular filtration rate alone. As such, a better evaluation of sodium and water handling by the renal tubules allows to determine the efficiency of loop diuretics (loop diuretic response and efficiency). Also, though neurohumoral blockers may induce modest deteriorations in glomerular filtration rate, their use is associated with improved long-term outcome. Therefore, a better understanding of the role of cardio-renal interactions in heart failure in symptom development, disease progression and prognosis is essential. Indeed, perhaps even misinterpretation of kidney function is a leading cause of not attaining decongestion in acute heart failure and insufficient dosing of guideline-directed medical therapy in general. This position paper of the Heart Failure Association Working Group on Cardio-Renal Dysfunction aims at improving insights into the interpretation of renal function assessment in the different heart failure states, with the goal of improving heart failure care.