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CC BY-NC-ND 4.0 · Dtsch Med Wochenschr 2021; 146(06): e47-e55
DOI: 10.1055/a-1307-8652
Review

Symptomkontrolle bei Herzinsuffizienzpatienten – was tun bei abfallender GFR und bei Hyperkaliämie?

Symptom control in heart failure patients – how to handle GFR decrease and hyperkalaemia
Vincent Brandenburg
1   Klinik für Kardiologie, Nephrologie und Internistische Intensivmedizin, Rhein-Maas-Klinikum, Würselen
,
Johann Bauersachs
2   Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover
,
Michael Böhm
3   Innere Medizin III – Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar
,
Danilo Fliser
4   Innere Medizin IV – Nieren- und Hochdruckkrankheiten, Universitätsklinikum des Saarlandes, Homburg/Saar
,
Stefan Frantz
5   Medizinische Klinik und Poliklinik I (Kardiologie, Endokrinologie, Nephrologie, Pneumologie, Intensiv- und Notfallmedizin) Universitätsklinikum Würzburg
,
Norbert Frey
6   Klinik für Innere Medizin III (Schwerpunkt Kardiologie, Angiologie und Intensivmedizin), Universitätsklinikum Schleswig-Holstein, Kiel
,
Gerd Hasenfuß
7   Herzzentrum, Abt. Kardiologie und Pneumologie, Universitätsmedizin Göttingen
,
Jan T. Kielstein
8   Klinik für Nephrologie, Blutreinigung und Rheumatologie, Klinikum Braunschweig
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Zusammenfassung

Bei Patienten mit Herzinsuffizienz und reduzierter Ejektionsfraktion wird durch eine optimierte medikamentöse Therapie sowohl die Symptomkontrolle verbessert als auch die Mortalität gesenkt. Eckpfeiler der Herzinsuffizienztherapie sind dabei Medikamente mit Einfluss auf das Renin-Angiotensin-Aldosteron-System, sogenannte RAAS-Inhibitoren. Dieser Artikel stellt einen kardiologisch-nephrologischen Konsens zur praxisorientierten Hilfestellung bei abnehmender glomerulärer Filtrationsrate oder Anstieg des Serum-Kaliumspiegels vor. Dies sind die 2 häufigsten Gründe für eine Dosisreduktion oder das Absetzen von prognoseverbessernden Medikamenten bei Herzinsuffizienzpatienten.

Abstract

For heart failure patients with reduced ejection fraction, optimised medication improves symptom control and reduces mortality. Substances influencing the renin-angiotensin-aldosteron-system, so-called RAAS-inhibitors, are the cornerstone of heart failure treatment. This article summarises a consensus between experts in cardiology and in nephrology on a pragmatic approach to manage a drop in glomerular filtration rate and incident hyperkalaemia – the two most common reasons for reducing or discontinuing heart failure medication.

Schlüsselwörter

Herzinsuffizienz - Niereninsuffizienz - glomeruläre Filtrationsrate - Hyperkaliämie

Key words

heart failure - chronic kidney disease - glomerular filtration rate - hyperkalaemia


Publication History

Article published online:
22 January 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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