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Kardiorenales Syndrom

Grenzen der Herzinsuffizienztherapie

Cardiorenal syndrome

Limits of heart failure therapy

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Zusammenfassung

Das kardiorenale Syndrom ist eine interdisziplinäre Herausforderung mit zunehmender gesundheitsökonomischer Relevanz. Das gleichzeitige Vorliegen einer Niereninsuffizienz ist bei herzinsuffizienten Patienten ein starker negativer Prädiktor für Mortalität. Aus diesem Grund ist für die erfolgreiche Therapie des kardiorenalen Syndroms eine enge Kooperation zwischen Kardiologen und Nephrologen erforderlich. Aber auch eine gute Compliance der betroffenen Patienten ist eine wichtige Voraussetzung, um die Symptome des kardiorenalen Syndroms zu verbessern und die Dekompensationshäufigkeit zu vermindern. Bei Patienten mit kardiorenalem Syndrom sollte zunächst eine umfassende kardiologische und nephrologische Diagnostik erfolgen. Die konservativen medikamentösen, diätetischen und ggf. elektrischen Therapieoptionen sollten unbedingt vollständig ausgeschöpft werden. Bei therapierefraktärer hypervolämischer Herzinsuffizienz kann als letzte Möglichkeit eine additive Nierenersatztherapie indiziert sein, selbst wenn noch keine terminale Niereninsuffizienz besteht. Bei akuter kardialer Dekompensation mit potenziell vital bedrohlichen Komplikationen sollte zunächst eine extrakorporale Nierenersatztherapie (z. B. Ultrafiltration oder Hämodialyse) eingesetzt werden. Falls es sich jedoch um eine therapierefraktäre Herzinsuffizienz mit chronisch zunehmender Niereninsuffizienz und rezidivierenden hydropischen Dekompensationen handelt, ist eine Peritonealdialyse zur kontinuierlichen Volumenelimination zu bevorzugen. Die ersten Auswertungen des Registers der Deutschen Gesellschaft für Nephrologie (DGfN, http://www.herz-niere.de) zu Nierenersatzverfahren beim kardiorenalen Syndrom bestätigen, dass durch Peritonealdialyse die Häufigkeit der Hospitalisierung und somit auch die Lebensqualität der Patienten verbessert werden kann.

Abstract

The cardiorenal syndrome is an interdisciplinary challenge with increasing health economic relevance. Renal failure is a strong predictor for mortality in patients with severe congestive heart failure (CHF) and CHF is one of the fastest increasing morbidities in western countries. For successful therapy a close cooperation between cardiology und nephrology is required. Moreover, a good compliance of the patient is needed to improve symptoms and to reduce the frequency of cardiac decompensation. A broad cardiological and nephrological evaluation and consideration of optimal conservative options according to national and international guidelines are essential. However, a renal replacement therapy might be helpful in patients with refractory heart failure even if they are not dialysis-dependent. In cases of acute heart and renal failure an intensive care management might be necessary to reduce volume overload with the help of extracorporeal ultrafiltration or a dialysis modality. Nevertheless, in cases of chronic refractory CHF peritoneal dialysis should be preferred. The first analysis of the registry of the German Society of Nephrology (http://www.herz-niere.de) confirmed that there is a benefit for health-related quality of life in chronic CHF patients treated with peritoneal dialysis.

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Authors and Affiliations

  1. Sektion Nephrologie, Medizinische Universitätsklinik Heidelberg, Im Neuenheimer Feld 162, 69120, Heidelberg, Deutschland

    L. Großekettler & V. Schwenger

  2. Klinik für Herzchirurgie, Chirurgische Universitätsklinik Heidelberg, Heidelberg, Deutschland

    B. Schmack

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  1. L. Großekettler
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  2. B. Schmack
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  3. V. Schwenger
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Correspondence to L. Großekettler.

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Großekettler, L., Schmack, B. & Schwenger, V. Kardiorenales Syndrom. Herz 38, 569–577 (2013). https://doi.org/10.1007/s00059-013-3847-6

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