Der Kardiologe

, 3:489 | Cite as

Herz und Niere

Von der Risikostratifikation bis zu Wechselwirkungen der medikamentösen Therapien
CME Weiterbildung · Zertifizierte Fortbildung

Zusammenfassung

Das kardiorenale Syndrom (CRS) findet sich im Krankheitsgut sowohl von Notaufnahmen, von Intensivstationen, insgesamt von Krankenhäusern, aber auch in Arztpraxen zunehmend häufiger. Ursache ist die demografische Entwicklung mit multimorbiden Patienten aufgrund kardiovaskulärer Risikokonstellationen. Oftmals bedingt eine Herzerkrankung auch eine Nierenerkrankung und umgekehrt. Das Management dieser Patienten ist schwierig, insbesondere da sich häufig widerstreitende Therapieziele finden. Für Nierenerkrankungen (CKD) gilt, dass diese kardiovaskuläre Risikofaktoren nicht nur leicht verstärken, sondern oftmals multiplizieren bis hin zu einer 100-fach höheren Erkrankungsrate an kardiovaskulären Erkrankungen (CVD). Weiterhin ist festzuhalten, dass eine CKD einen alleinigen kardiovaskulären Risikofaktor darstellt und derzeit in westlichen Industrieländern z. B. einen Diabetes mellitus als Risikofaktor für CVD deutlich überholt hat. Dies findet jedoch noch keinen Niederschlag im Bewusstsein von Patienten und Ärzten. Patienten mit CRS bedürfen modifizierter Therapien im Vergleich zu Patienten mit CVD ohne CKD. Die Therapieziele sind unterschiedlich, und Ergebnisse aus Studien mit Nierengesunden können nicht einfach auf diese Population extrapoliert werden.

Schlüsselwörter

Niereninsuffizienz Akutes Nierenversagen Kardiorenales Syndrom Kardiovaskuläre Erkrankungen Risikostratifikation 

Heart and kidney

From risk stratification to the interactions of pharmacotherapy

Abstract

The cardiorenal syndrome (CRS) is seen in increasing numbers in emergency rooms, intensive care units, hospitals as a whole and outpatient departments. This is caused by the demographic shifts that lead to increasing numbers of elderly patients with multimorbidities. Often a heart disease is causing kidney failure and vice versa. The management of these patients is difficult due to the fact that often the goals of therapy are opposite. Patients with chronic kidney disease (CKD) have a 100-fold increased risk for the development of cardiovascular diseases (CVD). CKD alone is an important cardiovascular risk factor and has surpassed diabetes mellitus as a risk factor by far. However, awareness of this is low among doctors and patients. The treatment of patients with CRS is different from patients with CVD alone. The goals of therapy are different and the findings of studies in patients with CVD without CKD cannot simply be extended to these patients.

Keywords

Renal impairment Acute kidney failure Cardiorenal syndrome Cardiovascular disease Risk stratification 

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Copyright information

© Springer Medizin Verlag 2009

Authors and Affiliations

  1. 1.Abteilung für Allgemeine Innere Medizin und NephrologieNotaufnahmezentrum, Robert-Bosch-KrankenhausStuttgartDeutschland

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