Medizinische Klinik

, Volume 105, Issue 3, pp 142–149 | Cite as

Das kardiorenale Syndrom

Übersicht

Zusammenfassung

... auf Herz und Niere geprüft: Diese alte volkstümliche Redewendung findet in der modernen Medizin eine ungeahnt aktuelle Entsprechung. Im Zuge der zunehmenden Komorbiditäten bei höherer Lebenserwartung erreichen immer mehr Menschen Krankheitszustände, auf die der Begriff „kardiorenales Syndrom“ zutrifft. Während man früher unter „kardiorenalem Syndrom“ im engeren Sinne die gleichzeitige Einschränkung von Herz- und Nierenfunktion aufgrund verminderter renaler Perfusion im Rahmen einer Herzinsuffizienz verstanden hat, muss der Begriff heute weiter gefasst und erklärt werden – nicht zuletzt, um den zahlreichen Komorbiditäten gerecht zu werden. Nach einer aktuellen Klassifikation werden fünf Typen des kardiorenalen Syndroms unterschieden. Diese Unterscheidung ist hilfreich, um eine individuelle, der Grunderkrankung entsprechende Therapie zu entwickeln. Auf diese neue Klassifikation und die modernen Therapiekonzepte soll im vorliegenden Beitrag eingegangen werden.

Schlüsselwörter

Herzinsuffizienz Niereninsuffizienz Hypertonie Diabetes mellitus Dialyse Diuretika 

Cardiorenal Syndrome

Abstract

With increasing age of a population, the rate and severity of comorbidities are also growing, resulting in a rising number of people with a condition described as “cardiorenal syndrome”. Initially, cardiorenal syndrome defined the decline in cardiac and renal function due to diminished renal perfusion in the context of heart failure. However, in order to give consideration to the numerous comorbidities, nowadays the definition has been widened. Following a new classification, five types of cardiorenal syndrome are distinguished. Such a differentiation is helpful to find the appropriate therapeutic approach, according to the underlying disease. Therefore, the new classification and modern therapeutic concepts shall be presented here.

Key Words

Heart failure Renal failure Chronic kidney disease Hypertension Diabetes mellitus Dialysis Diuretics 

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Literatur

  1. 1.
    Ronco C, Haapio M, House AA, et al. Cardiorenal syndrome. J Am Coll Cardiol 2008;52:1527–39.CrossRefPubMedGoogle Scholar
  2. 2.
    Shulman NB, Ford CE, Hall WD, et al. Prognostic value of serum creatinine and effect of treatment of hypertension on renal function. Results from the hypertension detection and follow-up program. The Hypertension Detection and Follow-up Program Cooperative Group. Hypertension 1989;13:Suppl:I80–93.PubMedGoogle Scholar
  3. 3.
    Levey AS, Coresh J, Balk E, et al. National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med 2003;139:137–47.PubMedGoogle Scholar
  4. 4.
    Go AS, Chertow GM, Fan D, et al. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 2004;351:1296–305.CrossRefPubMedGoogle Scholar
  5. 5.
    Zehender M, Kasper W, Kauder E, et al. Right ventricular infarction as an independent predictor of prognosis after acute inferior myocardial infarction. N Engl J Med 1993;328:981–8.CrossRefPubMedGoogle Scholar
  6. 6.
    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;53:582–8.CrossRefPubMedGoogle Scholar
  7. 7.
    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;53:589–96.CrossRefPubMedGoogle Scholar
  8. 8.
    Mann JF, Schmieder RE, McQueen M, et al. Renal outcomes with telmisartan, ramipril, or both, in people at high vascular risk (the ONTARGET study): a multicentre, randomised, double-blind, controlled trial. Lancet 2008;372:547–53.CrossRefPubMedGoogle Scholar
  9. 9.
    Pfeffer MA, McMurray JJV, Velazquez EJ, et al., the Valsartan in Acute Myocardial Infarction Trial Investigators. Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both. N Engl J Med 2003;349:1893–906.CrossRefPubMedGoogle Scholar
  10. 10.
    Cohn JN, Tognoni G, the Valsartan Heart Failure Trial Investigators. A randomized trial of the angiotensin-receptor blocker valsartan in chronic heart failure. N Engl J Med 2001;345:1667–75.CrossRefPubMedGoogle Scholar
  11. 11.
    Pitt B, Zannad F, Remme WJ, et al. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators. N Engl J Med 1999;341:709–17.CrossRefPubMedGoogle Scholar
  12. 12.
    Juurlink DN, Mamdani MM, Lee DS, et al. Rates of hyperkalemia after publication of the Randomized Aldactone Evaluation Study. N Engl J Med 2004;351:543–51.CrossRefPubMedGoogle Scholar
  13. 13.
    Ronco C, Ricci Z, Bellomo R, Bedogni F. Extra-corporeal ultrafiltration for the treatment of overhydration and congestive heart failure. Cardiology 2001;96:155–68.CrossRefPubMedGoogle Scholar
  14. 14.
    Barrett BJ, Parfrey PS. Preventing nephropathy induced by contrast medium. N Engl J Med 2006;354:379–86.CrossRefPubMedGoogle Scholar
  15. 15.
    Persson PB, Hansell P, Liss P. Pathophysiology of contrast medium-induced nephropathy. Kidney Int 2005;68:14–22.CrossRefPubMedGoogle Scholar
  16. 16.
    White CJ, Jaff MR, Haskal ZJ, et al. Indications for renal arteriography at the time of coronary arteriography: a science advisory from the American Heart Association Committee on Diagnostic and Interventional Cardiac Catheterization, Council on Clinical Cardiology, and the Councils on Cardiovascular Radiology and Intervention and on Kidney in Cardiovascular Disease. Circulation 2006;114:1892–5.CrossRefPubMedGoogle Scholar
  17. 17.
    Anavekar NS, Pfeffer MA. Cardiovascular risk in chronic kidney disease. Kidney Int Suppl 2004;92:S11–5.CrossRefPubMedGoogle Scholar
  18. 18.
    Anavekar NS, McMurray JJV, Velazquez EJ, et al. Relation between renal dysfunction and cardiovascular outcomes after myocardial infarction. N Engl J Med 2004;351:1285–95.CrossRefPubMedGoogle Scholar
  19. 19.
    Eckardt KU, Berns JS, Rocco MV, Kasiske BL. Definition and classification of CKD: the debate should be about patient prognosis — a position statement from KDOQI and KDIGO. Am J Kidney Dis 2009;53:915–20.CrossRefPubMedGoogle Scholar
  20. 20.
    Hallan SI, Ritz E, Lydersen S, et al. Combining GFR and albuminuria to classify CKD improves prediction of ESRD. J Am Soc Nephrol 2009;20:1069–77.CrossRefPubMedGoogle Scholar
  21. 21.
    van der Velde M, Halbesma N, de Charro FT, et al. Screening for albuminuria identifies individuals at increased renal risk. J Am Soc Nephrol 2009;20:852–62.CrossRefPubMedGoogle Scholar
  22. 22.
    Wanner C, Krane V, Marz W, et al. Atorvastatin in patients with type 2 diabetes mellitus undergoing hemodialysis. N Engl J Med 2005;353:238–48.CrossRefPubMedGoogle Scholar
  23. 23.
    Fellstrom BC, Jardine AG, Schmieder RE, et al. Rosuvastatin and cardiovascular events in patients undergoing hemodialysis. N Engl J Med 2009;360:1395–407.CrossRefPubMedGoogle Scholar
  24. 24.
    Baigent C, Landry M. Study of Heart and Renal Protection (SHARP). Kidney Int Suppl 2003;84:S207–10.CrossRefPubMedGoogle Scholar
  25. 25.
    Singh AK, Szczech L, Tang KL, et al. Correction of anemia with epoetin alfa in chronic kidney disease. N Engl J Med 2006;355:2085–98.CrossRefPubMedGoogle Scholar
  26. 26.
    Drueke TB, Locatelli F, Clyne N, et al. Normalization of hemoglobin level in patients with chronic kidney disease and anemia. N Engl J Med 2006;355:2071–84.CrossRefPubMedGoogle Scholar
  27. 27.
    Pfeffer MA, Burdmann EA, Chen CY, et al., TREAT Investigators. A trial of darbepoetin alfa in type 2 diabetes and chronic kidney disease. N Engl J Med 2009;361:2019–32.CrossRefPubMedGoogle Scholar
  28. 28.
    Block GA, Raggi P, Bellasi A, et al. Mortality effect of coronary calcification and phosphate binder choice in incident hemodialysis patients. Kidney Int 2007;71:438–41.CrossRefPubMedGoogle Scholar
  29. 29.
    Block GA, Spiegel DM, Ehrlich J, et al. Effects of sevelamer and calcium on coronary artery calcification in patients new to hemodialysis. Kidney Int 2005;68:1815–24.CrossRefPubMedGoogle Scholar
  30. 30.
    Suki WN, Zabaneh R, Cangiano JL, et al. Effects of sevelamer and calcium-based phosphate binders on mortality in hemodialysis patients. Kidney Int 2007;72:1130–7.CrossRefPubMedGoogle Scholar
  31. 31.
    Lins RL, Elseviers MM, Van der Niepen P, et al. Intermittent versus continuous renal replacement therapy for acute kidney injury patients admitted to the intensive care unit: results of a randomized clinical trial. Nephrol Dial Transplant 2009;24:512–8.CrossRefPubMedGoogle Scholar
  32. 32.
    Schiffl H, Lang SM, Fischer R. Daily hemodialysis and the outcome of acute renal failure. N Engl J Med 2002;346:305–10.CrossRefPubMedGoogle Scholar
  33. 33.
    Schiffl H. More-intensive renal replacement therapy has no benefit in critically ill patients with acute kidney injury. Nat Clin Pract Nephrol 2008;4:596–7.CrossRefPubMedGoogle Scholar

Copyright information

© Urban & Vogel, Muenchen 2010

Authors and Affiliations

  1. 1. Klinik für Nephrologie und DialyseverfahrenKlinikum LüdenscheidLüdenscheidGermany
  2. 2.Direktor der Klinik für Nephrologie und DialyseverfahrenKlinikum LüdenscheidLüdenscheidGermany

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