Kardiorenales Syndrom

Zusammenfassung

Das kardiorenale Syndrom als Folge einer akuten (Typ 1) oder chronischen (Typ 2) Herzinsuffizienz ist häufig, kompliziert die Behandlung z. T. erheblich und wirkt sich sehr ungünstig auf die Prognose aus. Als Auslöser kommen sowohl hämodynamische (insbesondere die Reduktion des renalen Blutflusses) als auch neurohumoral-metabolische und toxische Faktoren infrage, die ihrerseits wiederum kardiodepressiv wirken können. Das Monitoring der Nierenfunktion sollte über die mithilfe der CKD-EPI-Formel abgeschätzte GFR erfolgen. Kausale Therapieansätze sind bisher nicht gut etabliert, weshalb der Prävention ein hoher Stellenwert zukommt. Umsichtiges Volumenmanagement und angepasste diuretische Verfahren stehen im Vordergrund der überwiegend symptomatischen Therapie.

Abstract

A cardiorenal syndrome originating in the context of acute (type 1) or chronic (type 2) heart failure is common, markedly complicates treatment, and is associated with adverse prognosis. Hemodynamic (in particular reduced renal perfusion) and neurohumoral-metabolic as well as toxic factors are acknowledged trigger factors, which subsequently may aggravate cardiodepression. Monitoring of renal function should be performed using estimated GFR based on the CKD-EPI equation. Causal therapy is not well established, hence preventive measures are essential. Prudent management of fluid status and individually tailored diuresis are the cornerstones of symptomatic treatment.

Schlüsselwörter

kardiorenales Syndrom - Herzinsuffizienz - Biomarker

Key words

cardiorenal syndrome - heart failure - biomarkers

• Literatur

• 1 Coresh J, Astor BC, Greene T et al. Prevalence of chronic kidney disease and decreased kidney function in the adult US population: Third National Health and Nutrition Examination Survey. Am J Kidney Dis 2003; 41: 1-12
• 2 Bock JS, Gottlieb SS. Cardiorenal syndrome: new perspectives. Circulation 2010; 121: 2592-2600
• 3 Ronco C, Haapio M, House AA et al. Cardiorenal syndrome. J Am Coll Cardiol 2008; 52: 1527-1539
• 4 Heywood JT, Fonarow GC, Costanzo MR et al. High prevalence of renal dysfunction and its impact on outcome in 118,465 patients hospitalized with acute decompensated heart failure: a report from the ADHERE database. J Card Fail 2007; 13: 422-430
• 5 Forman DE, Butler J, Wang Y et al. Incidence, predictors at admission, and impact of worsening renal function among patients hospitalized with heart failure. J Am Coll Cardiol 2004; 43: 61-67
• 6 Damman K, Navis G, Voors AA et al. Worsening renal function and prognosis in heart failure: systematic review and meta-analysis. J Card Fail 2007; 13: 599-608
• 7 Liang KV, Williams AW, Greene EL et al. Acute decompensated heart failure and the cardiorenal syndrome. Crit Care Med 2008; 36: S75-S88
• 8 Hunt SA, Baker DW, Chin MH et al. ACC/AHA Guidelines for the Evaluation and Management of Chronic Heart Failure in the Adult: Executive Summary A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1995 Guidelines for the Evaluation and Management of Heart Failure): Developed in Collaboration With the International Society for Heart and Lung Transplantation; Endorsed by the Heart Failure Society of America. Circulation 2001; 104: 2996-3007
• 9 Sarraf M, Masoumi A, Schrier RW. Cardiorenal syndrome in acute decompensated heart failure. Clin J Am Soc Nephrol 2009; 4: 2013-2026
• 10 Nohria A, Hasselblad V, Stebbins A et al. Cardiorenal interactions: insights from the ESCAPE trial. J Am Coll Cardiol 2008; 51: 1268-1274
• 11 Damman K, van Deursen VM, Navis G et al. Increased central venous pressure is associated with impaired renal function and mortality in a broad spectrum of patients with cardiovascular disease. J Am Coll Cardiol 2009; 53: 582-588
• 12 Mullens W, Abrahams Z, Francis GS et al. Importance of venous congestion for worsening of renal function in advanced decompensated heart failure. J Am Coll Cardiol 2009; 53: 589-596
• 13 van Veldhuisen DJ, Ruilope LM, Maisel AS et al. Biomarkers of renal injury and function: diagnostic, prognostic and therapeutic implications in heart failure. Eur Heart J 2015; Nov 4. pii: ehv588; [Epub ahead of print]
• 14 Kirklin JK, Naftel DC, Kormos RL et al. Quantifying the effect of cardiorenal syndrome on mortality after left ventricular assist device implant. J Heart Lung Transplant 2013; 32: 1205-1213
• 15 Testani JM, Chen J, McCauley BD et al. Potential effects of aggressive decongestion during the treatment of decompensated heart failure on renal function and survival. Circulation 2010; 122: 265-272
• 16 Testani JM, Brisco MA, Chen J et al. Timing of hemoconcentration during treatment of acute decompensated heart failure and subsequent survival: importance of sustained decongestion. J Am Coll Cardiol 2013; 62: 516-524
• 17 Costanzo MR, Johannes RS, Pine M et al. The safety of intravenous diuretics alone versus diuretics plus parenteral vasoactive therapies in hospitalized patients with acutely decompensated heart failure: a propensity score and instrumental variable analysis using the Acutely Decompensated Heart Failure National Registry (ADHERE) database. Am Heart J 2007; 154: 267-277
• 18 Fitchett D, Zinman B, Wanner C et al. Heart failure outcomes with empagliflozin in patients with type 2 diabetes at high cardiovascular risk: results of the EMPA-REG OUTCOME® trial. Eur Heart J 2016; Jan 26. pii: ehv728; [Epub ahead of print]