Dtsch Med Wochenschr 2019; 144(13): 910-916
DOI: 10.1055/a-0768-5899
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Das kardiorenale Syndrom

The Cardiorenal Syndrome
Florian Gunnar Scurt
,
Tim Kuczera
,
Peter René Mertens
,
Christos Chatzikyrkou
Further Information

Publication History

Publication Date:
28 June 2019 (online)

Abstract

Chronic heart failure is associated with high morbidity and mortality and is the most common hospital diagnosis for elderly patients. Concomitant or superimposed acute or chronic kidney injury, as is the case with cardiorenal syndrome, has a dramatic impact on the outcome. The inhibition of the neurohumoral axis and the adequate treatment of hypervolemia are fundamental elements of modern cardiac insufficiency therapies. In addition to optimal conservative therapy, there are other options: VAD implantation, hemodialysis and peritoneal dialysis. The PD offers biological and clinical benefits as an additive therapy for the treatment of patients with heart failure, refractory hypervolemia and non-urinary renal failure.

Die chronische Herzinsuffizienz ist bei älteren Patienten die häufigste Aufnahmediagnose zur stationären Krankenhausbehandlung. Grundelemente moderner Herzinsuffizienztherapien sind die Hemmung der neurohumoralen Achse und die Behandlung der Hypervolämie. Ist zusätzlich die Nierenfunktion eingeschränkt, verschlechtert sich die Prognose deutlich. Grundlagen, Diagnostik und therapeutische Optionen werden in diesem Beitrag praxisnah aufbereitet.

 
  • Literatur

  • 1 Ronco C, Haapio M, House AA. et al. Cardiorenal syndrome. J Am Coll Cardiol 2008; 52: 1527-1539 . doi:10.1016/j.jacc.2008.07.051
  • 2 Heidenreich PA, Albert NM, Allen LA. et al. Forecasting the impact of heart failure in the United States: a policy statement from the American Heart Association. Circ Heart Fail 2013; 6: 606-619 . doi:10.1161/HHF.0b013e318291329a
  • 3 Udelson JE, Stevenson LW. The Future of Heart Failure Diagnosis, Therapy, and Management. Circulation 2016; 133: 2671-2686 . doi:10.1161/CIRCULATIONAHA.116.023518
  • 4 Danziger J, Hoenig MP. The Role of the Kidney in Disorders of Volume: Core Curriculum 2016. Am J Kidney Dis 2016; 68: 808-816 . doi:10.1053/j.ajkd.2016.05.028
  • 5 Ross EA. Congestive renal failure: the pathophysiology and treatment of renal venous hypertension. J Card Fail 2012; 18: 930-938 . doi:10.1016/j.cardfail.2012.10.010
  • 6 Tonelli M, Karumanchi SA, Thadhani R. Epidemiology and Mechanisms of Uremia-Related Cardiovascular Disease. Circulation 2016; 133: 518-536 . doi:10.1161/CIRCULATIONAHA.115.018713
  • 7 Doi K, Rabb H. Impact of acute kidney injury on distant organ function: recent findings and potential therapeutic targets. Kidney Int 2016; 89: 555-564 . doi:10.1016/j.kint.2015.11.019
  • 8 Abuelo JG. Normotensive ischemic acute renal failure. N Engl J Med 2007; 357: 797-805 . doi:10.1056/NEJMra064398
  • 9 Abraham WT, Stevenson LW, Bourge RC. et al. Sustained efficacy of pulmonary artery pressure to guide adjustment of chronic heart failure therapy: complete follow-up results from the CHAMPION randomised trial. Lancet 2016; 387: 453-461 . doi:10.1016/S0140-6736(15)00723-0
  • 10 Nieminen MS, Bohm M, Cowie MR. et al. Executive summary of the guidelines on the diagnosis and treatment of acute heart failure: the Task Force on Acute Heart Failure of the European Society of Cardiology. Eur Heart J 2005; 26: 384-416 . doi:10.1093/eurheartj/ehi044
  • 11 Lala A, McNulty SE, Mentz RJ. et al. Relief and Recurrence of Congestion During and After Hospitalization for Acute Heart Failure: Insights From Diuretic Optimization Strategy Evaluation in Acute Decompensated Heart Failure (DOSE-AHF) and Cardiorenal Rescue Study in Acute Decompensated Heart Failure (CARESS-HF). Circ Heart Fail 2015; 8: 741-748 . doi:10.1161/CIRCHEARTFAILURE.114.001957
  • 12 Sundaram V, Fang JC. Gastrointestinal and Liver Issues in Heart Failure. Circulation 2016; 133: 1696-1703 . doi:10.1161/CIRCULATIONAHA.115.020894
  • 13 Anand IS. Cardiorenal syndrome: a cardiologist's perspective of pathophysiology. Clin J Am Soc Nephrol 2013; 8: 1800-1807 . doi:10.2215/CJN.04090413
  • 14 Shah SJ, Kitzman DW, Borlaug BA. et al. Phenotype-Specific Treatment of Heart Failure With Preserved Ejection Fraction: A Multiorgan Roadmap. Circulation 2016; 134: 73-90 . doi:10.1161/CIRCULATIONAHA.116.021884
  • 15 Untersteller K, Girerd N, Duarte K. et al. NT-proBNP and Echocardiographic Parameters for Prediction of Cardiovascular Outcomes in Patients with CKD Stages G2-G4. Clin J Am Soc Nephrol 2016; 11: 1978-1988 . doi:10.2215/CJN.01660216
  • 16 Torino C, Gargani L, Sicari R. et al. The Agreement between Auscultation and Lung Ultrasound in Hemodialysis Patients: The LUST Study. Clin J Am Soc Nephrol 2016; 11: 2005-2011 . doi:10.2215/CJN.03890416
  • 17 Marino F, Martorano C, Tripepi R. et al. Subclinical pulmonary congestion is prevalent in nephrotic syndrome. Kidney Int 2016; 89: 421-428 . doi:10.1038/ki.2015.279
  • 18 Iida N, Seo Y, Sai S. et al. Clinical Implications of Intrarenal Hemodynamic Evaluation by Doppler Ultrasonography in Heart Failure. JACC Heart failure 2016; 4: 674-682 . doi:10.1016/j.jchf.2016.03.016
  • 19 Hanna EB, Hanna Deschamps E. Acute heart failure: acute cardiorenal syndrome and role of aggressive decongestion. Clin Cardiol 2014; 37: 773-778 . doi:10.1002/clc.22337
  • 20 Heywood JT, Fonarow GC, Costanzo MR. et al. High prevalence of renal dysfunction and its impact on outcome in 118465 patients hospitalized with acute decompensated heart failure: a report from the ADHERE database. J Card Fail 2007; 13: 422-430 . doi:10.1016/j.cardfail.2007.03.011
  • 21 Testani JM, McCauley BD, Kimmel SE. et al. Characteristics of patients with improvement or worsening in renal function during treatment of acute decompensated heart failure. Am J Cardiol 2010; 106: 1763-1769 . doi:10.1016/j.amjcard.2010.07.050
  • 22 Ellison DH, Felker GM. Diuretic Treatment in Heart Failure. N Engl J Med 2017; 377: 1964-1975 . doi:10.1056/NEJMra1703100
  • 23 Costanzo MR, Guglin ME, Saltzberg MT. et al. Ultrafiltration versus intravenous diuretics for patients hospitalized for acute decompensated heart failure. J Am Coll Cardiol 2007; 49: 675-683 . doi:10.1016/j.jacc.2006.07.073
  • 24 Bart BA, Goldsmith SR, Lee KL. et al. Cardiorenal rescue study in acute decompensated heart failure: rationale and design of CARRESS-HF, for the Heart Failure Clinical Research Network. J Card Fail 2012; 18: 176-182 . doi:10.1016/j.cardfail.2011.12.009
  • 25 Marenzi G, Muratori M, Cosentino ER. et al. Continuous ultrafiltration for congestive heart failure: the CUORE trial. J Card Fail 2014; 20: 378.e371–379
  • 26 Costanzo MR, Negoianu D, Jaski BE. et al. Aquapheresis Versus Intravenous Diuretics and Hospitalizations for Heart Failure. JACC Heart failure 2016; 4: 95-105 . doi:10.1016/j.jchf.2015.08.005
  • 27 Rogers JG, Pagani FD, Tatooles AJ. et al. Intrapericardial Left Ventricular Assist Device for Advanced Heart Failure. N Engl J Med 2017; 376: 451-460 . doi:10.1056/NEJMoa1602954
  • 28 Miller LW, Pagani FD, Russell SD. et al. Use of a continuous-flow device in patients awaiting heart transplantation. N Engl J Med 2007; 357: 885-896 . doi:10.1056/NEJMoa067758
  • 29 Schwenger V, Remppis BA, Westenfeld R. et al. Dialysis and ultrafiltration therapy in patients with cardio-renal syndrome: recommendations of the working group "heart-kidney" of the German Cardiac Society and the German Society of Nephrology. Dtsch Med Wochenschr 2014; 139: e1-e8 . doi:10.1055/s-0033-1360037
  • 30 Froehlich H, Katus HA, Tager T. et al. Peritoneal ultrafiltration in end-stage chronic heart failure. Clin Kidney J 2015; 8: 219-225 . doi:10.1093/ckj/sfv007
  • 31 Courivaud C, Kazory A, Crepin T. et al. Peritoneal dialysis reduces the number of hospitalization days in heart failure patients refractory to diuretics. Perit Dial Int 2014; 34: 100-108 . doi:10.3747/pdi.2012.00149
  • 32 Nunez J, Gonzalez M, Minana G. et al. Continuous ambulatory peritoneal dialysis as a therapeutic alternative in patients with advanced congestive heart failure. Eur J Heart Fail 2012; 14: 540-548 . doi:10.1093/eurjhf/hfs013
  • 33 Koch M, Haastert B, Kohnle M. et al. Peritoneal dialysis relieves clinical symptoms and is well tolerated in patients with refractory heart failure and chronic kidney disease. Eur J Heart Fail 2012; 14: 530-539 . doi:10.1093/eurjhf/hfs035
  • 34 Kervella D, Lemoine S, Sens F. et al. Cystatin C Versus Creatinine for GFR Estimation in CKD Due to Heart Failure. Am J Kidney Dis 2017; 69: 321-323 . doi:10.1053/j.ajkd.2016.09.016