Advertisement

Der Internist

, Volume 59, Issue 5, pp 420–427 | Cite as

Herz-Nieren-Achse

Beziehung von Herz- und Niereninsuffizienz als Komorbiditäten
  • M. Zeisberg
  • M. J. Koziolek
Schwerpunkt: Komorbiditäten bei Herzinsuffizienz
  • 1.1k Downloads

Zusammenfassung

Herz- und Niereninsuffizienz treten durch Wirkmechanismen, die in beiden Erkrankungen greifen, häufig gemeinsam auf. Bei Koinzidenz der beiden Erkrankungen verschlechtern sich Verlauf, Symptomatik und Outcome. Therapeutisch ergeben sich Limitierungen durch eine eingeschränkte Evidenzlage bei höhergradiger Niereninsuffizienz, eine häufige Verschlechterung der Nierenfunktion unter Therapie und das Auftreten einer Hyperkaliämie, sodass diese Patientengruppe einer gesteigerten Aufmerksamkeit mit häufigeren Arzt-Patienten-Kontakten bedarf. Eine besondere Herausforderung stellt die sogenannte Diuretikaresistenz dar, die unter Umständen eine extrakorporale Entwässerung nötig macht.

Schlüsselwörter

Anämie Baroreflex Diuretikaresistenz Peritonealdialyse Ultrafiltration 

Cardio-renal axis

Relationship of heart failure and renal insufficiency as comorbidities

Abstract

Heart failure and kidney dysfunction are common comorbidities with overlapping and synergizing mechanisms. Coincidence of both pathologies aggravates disease progression rates, symptoms, and outcomes. The treatment of patients with advanced renal insufficiency is faced with limited evidence for therapies that are standard of care in patients with normal and moderate kidney failure, frequent deterioration of kidney function during therapy, and onset of hyperkalemia, which pose challenges for clinical care, requiring intensified physician–patient contacts. A special challenge is the so-called diuretic resistance, which may require extracorporeal drainage.

Keywords

Anemia Baroreflex Drug resistance, diuretics Peritoneal dialysis Ultrafiltration 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

M.J. Koziolek gibt Vortragshonorare und Forschungsunterstützung von Novartis Pharma und CVRx an, M. Zeisberg Vortragshonorare und Forschungsunterstützung von Novartis Pharma.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Literatur

  1. 1.
    Abraham WT, Zile MR, Weaver FA et al (2015) Baroreflex activation therapy for the treatment of heart failure with a reduced ejection fraction. JACC Heart Fail 3:487–496CrossRefPubMedGoogle Scholar
  2. 2.
    Bansal N, Katz R, Robinson-Cohen C et al (2017) Absolute rates of heart failure, coronary heart disease, and stroke in chronic kidney disease: an analysis of 3 community-based cohort studies. JAMA Cardiol 2:314–318CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Bart BA, Boyle A, Bank AJ et al (2005) Ultrafiltration versus usual care for hospitalized patients with heart failure – the relief for acutely fluid-overloaded patients with decompensated congestive heart failure (RAPID-CHF) trial. J Am Coll Cardiol 46:2043–2046CrossRefPubMedGoogle Scholar
  4. 4.
    Bart BA, Goldsmith SR, Lee KL et al (2012) Ultrafiltration in decompensated heart failure with cardiorenal syndrome. N Engl J Med 367:2296–2304CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Cohn JN, Tognoni G, Valsartan Heart Failure Trial Investigators (2001) A randomized trial of the angiotensin-receptor blocker valsartan in chronic heart failure. N Engl J Med 345:1667–1675CrossRefPubMedGoogle Scholar
  6. 6.
    Costanzo MR, Saltzberg MT, Jessup M et al (2010) Ultrafiltration is associated with fewer rehospitalizations than continuous diuretic infusion in patients with decompensated heart failure: results from UNLOAD. J Card Fail 16:277–284CrossRefPubMedGoogle Scholar
  7. 7.
    Costanzo MR, Negoianu D, Fonarow GC et al (2015) Rationale and design of the aquapheresis versus intravenous diuretics and hospitalization for heart failure (AVOID-HF) trial. Am Heart J 170:471–482CrossRefPubMedGoogle Scholar
  8. 8.
    Damman K, Testani JM (2015) The kidney in heart failure: an update. Eur Heart J 36:1437–1444CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Desai AS (2009) Hyperkalemia in patients with heart failure: incidence, prevalence, and management. Curr Heart Fail Rep 6:272–280CrossRefPubMedGoogle Scholar
  10. 10.
    Ferrari L, Sada S, GrAm (Gruppo di Autoformazione Metodologica) (2015) Efficacy of angiotensin-neprilysin inhibition versus enalapril in patient with heart failure with a reduced ejection fraction. Intern Emerg Med 10:369–371CrossRefPubMedGoogle Scholar
  11. 11.
    Filippatos G, Anker SD, Bohm M et al (2016) A randomized controlled study of finerenone vs. eplerenone in patients with worsening chronic heart failure and diabetes mellitus and/or chronic kidney disease. Eur Heart J 37:2105–2114CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Giglioli C, Landi D, Cecchi E et al (2011) Effects of ULTRAfiltration vs. DIureticS on clinical, biohumoral and haemodynamic variables in patients with deCOmpensated heart failure: the ULTRADISCO study. Eur J Heart Fail 13:337–346CrossRefPubMedGoogle Scholar
  13. 13.
    Go AS, Yang JR, Ackerson LM et al (2006) Hemoglobin level, chronic kidney disease, and the risks of death and hospitalization in adults with chronic heart failure – the ANemia in CHronic heart failure: Outcomes and Resource utilization (ANCHOR) study. Circulation 113:2713–2723CrossRefPubMedGoogle Scholar
  14. 14.
    Group CTS (1987) Effects of enalapril on mortality in severe congestive heart failure. Results of the COoperative North Scandinavian ENalapril SUrvival Study (CONSENSUS). N Engl J Med 316:1429–1435CrossRefGoogle Scholar
  15. 15.
    Gwoo S, Kim YN, Shin HS et al (2014) Predictors of hyperkalemia risk after hypertension control with aldosterone blockade according to the presence or absence of chronic kidney disease. Nephron Clin Pract 128:381–386CrossRefPubMedGoogle Scholar
  16. 16.
    Hatamizadeh P, Fonarow GC, Budoff MJ et al (2013) Cardiorenal syndrome: pathophysiology and potential targets for clinical management. Nat Rev Nephrol 9:99–111CrossRefPubMedGoogle Scholar
  17. 17.
    Investigators S, Yusuf S, Pitt B et al (1992) Effect of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left ventricular ejection fractions. N Engl J Med 327:685–691CrossRefGoogle Scholar
  18. 18.
    Kazory A (2017) Fluid overload as a major target in management of cardiorenal syndrome: implications for the practice of peritoneal dialysis. World J Nephrol 6:168–175CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Kosiborod M, Rasmussen HS, Lavin P et al (2014) Effect of sodium zirconium cyclosilicate on potassium lowering for 28 days among outpatients with hyperkalemia: the HARMONIZE randomized clinical trial. JAMA 312:2223–2233CrossRefPubMedGoogle Scholar
  20. 20.
    Lechat P, Brunhuber KW, Hofmann R et al (1999) The Cardiac Insufficiency BIsoprolol Study II (CIBIS-II): a randomised trial. Lancet 353:9–13CrossRefGoogle Scholar
  21. 21.
    Lofman I, Szummer K, Dahlstrom U et al (2017) Associations with and prognostic impact of chronic kidney disease in heart failure with preserved, mid-range, and reduced ejection fraction. Eur J Heart Fail 19:1606–1614CrossRefPubMedGoogle Scholar
  22. 22.
    Lu R, Mucino-Bermejo MJ, Ribeiro LC et al (2015) Peritoneal dialysis in patients with refractory congestive heart failure: a systematic review. Cardiorenal Med 5:145–156CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Marenzi G, Muratori M, Cosentino ER et al (2014) Continuous ultrafiltration for congestive heart failure: the CUORE trial. J Card Fail 20:9–17CrossRefPubMedGoogle Scholar
  24. 24.
    McAlister FA, Ezekowitz J, Tarantini L et al (2012) Renal dysfunction in patients with heart failure with preserved versus reduced ejection fraction: impact of the new chronic kidney disease-epidemiology collaboration group formula. Circ Heart Fail 5:309–314CrossRefPubMedGoogle Scholar
  25. 25.
    McMurray JJ, Ostergren J, Swedberg K et al (2003) Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function taking angiotensin-converting-enzyme inhibitors: the CHARM-added trial. Lancet 362:767–771CrossRefPubMedGoogle Scholar
  26. 26.
    McMurray JJ, Packer M, Desai AS et al (2014) Angiotensin-neprilysin inhibition versus enalapril in heart failure. N Engl J Med 371:993–1004CrossRefPubMedGoogle Scholar
  27. 27.
    Pitt B, Zannad F, Remme WJ et al (1999) The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized aldactone evaluation study investigators. N Engl J Med 341:709–717CrossRefPubMedGoogle Scholar
  28. 28.
    Pitt B, Anker SD, Bushinsky DA et al (2011) Evaluation of the efficacy and safety of RLY5016, a polymeric potassium binder, in a double-blind, placebo-controlled study in patients with chronic heart failure (the PEARL-HF) trial. Eur Heart J 32:820–828CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Ponikowski P, Filippatos G, Colet JC et al (2015) The impact of intravenous ferric carboxymaltose on renal function: an analysis of the FAIR-HF study. Eur J Heart Fail 17:329–339CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Ponikowski P, Voors AA, Anker SD et al (2016) 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC ). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 37:2129–2200CrossRefPubMedGoogle Scholar
  31. 31.
    Ponikowski P, Voors AA, Anker SD et al (2016) 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 18:891–975CrossRefPubMedGoogle Scholar
  32. 32.
    Redfield MM (2016) Heart failure with preserved ejection fraction. N Engl J Med 375:1868–1877CrossRefPubMedGoogle Scholar
  33. 33.
    Ronco C, Haapio M, House AA et al (2008) Cardiorenal syndrome. J Am Coll Cardiol 52:1527–1539CrossRefPubMedGoogle Scholar
  34. 34.
    Saran R, Robinson B, Abbott KC et al (2017) US renal data system 2016 annual data report: epidemiology of kidney disease in the United States. Am J Kidney Dis 69:A7–A8CrossRefPubMedGoogle Scholar
  35. 35.
    Scrutinio D, Agostoni P, Gesualdo L et al (2015) Renal function and peak exercise oxygen consumption in chronic heart failure with reduced left ventricular ejection fraction. Circ J 79:583–591CrossRefPubMedGoogle Scholar
  36. 36.
    Testani JM, Coca SG, Shannon RP et al (2011) Influence of renal dysfunction phenotype on mortality in the setting of cardiac dysfunction: analysis of three randomized controlled trials. Eur J Heart Fail 13:1224–1230CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Virzi GM, Clementi A, Brocca A et al (2017) Epigenetics: a potential key mechanism involved in the pathogenesis of cardiorenal syndromes. J Nephrol.  https://doi.org/10.1007/s40620-017-0425-7 PubMedGoogle Scholar
  38. 38.
    Weir MR, Bakris GL, Bushinsky DA et al (2015) Patiromer in patients with kidney disease and hyperkalemia receiving RAAS inhibitors. N Engl J Med 372:211–221CrossRefPubMedGoogle Scholar
  39. 39.
    Yilmaz MB, Gayat E, Salem R et al (2011) Impact of diuretic dosing on mortality in acute heart failure using a propensity-matched analysis. Eur J Heart Fail 13:1244–1252CrossRefPubMedGoogle Scholar
  40. 40.
    Zannad F, McMurray JJ, Krum H et al (2011) Eplerenone in patients with systolic heart failure and mild symptoms. N Engl J Med 364:11–21CrossRefPubMedGoogle Scholar
  41. 41.
    Zinman B, Wanner C, Lachin JM et al (2015) Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med 373:2117–2128CrossRefPubMedGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.Klinik für Nephrologie und RheumatologieUniversitätsmedizin GöttingenGöttingenDeutschland

Personalised recommendations