Skip to main content
SpringerLink
Log in

Nierenersatzverfahren bei therapierefraktärer Herzinsuffizienz

Renal replacement therapy for refractory heart failure

  • Schwerpunkt
  • Published:
Der Internist Aims and scope Submit manuscript

Zusammenfassung

Bei Patienten mit therapierefraktärer hypervolämischer Herzinsuffizienz kann nach umfassender kardiologischer Diagnostik und Ausschöpfung konservativer Therapiemaßnahmen, auch wenn noch kein dialysepflichtiges Nierenversagen vorliegt, eine Nierenersatztherapie notwendig sein. Bei akuter kardialer Dekompensation und umgehender Notwendigkeit einer Nierenersatztherapie zur Beseitigung einer Hypervolämie oder Hyperkaliämie sollten bevorzugt extrakorporale Verfahren (Hämodialyse, Hämofiltration und Ultrafiltration) zum Einsatz kommen. Bei therapierefraktärer Herzinsuffizienz mit rezidivierenden hypervolämischen Dekompensationen oder kontinuierlicher Verschlechterung der Nierenfunktion ist hingegen primär eine Peritonealdialyse anzustreben. Voraussetzungen für die Behandlung dieser Patienten sind die ausgewiesene Expertise auf dem Gebiet der Herzinsuffizienz und Peritonealdialyse sowie die enge Kooperation zwischen Kardiologen und Nephrologen. Aufgrund der limitierten Datenlage sollten Behandlungsergebnisse im Register der Deutschen Gesellschaft für Nephrologie (http://www.herz-niere.de) erfasst werden.

Abstract

After broad cardiological and nephrological evaluation and consideration of optimal conservative options according to national and international guidelines, renal replacement therapy might be helpful in patients with refractory heart failure even if they are not dialysis-dependent. This is even more important as renal failure is a strong predictor for mortality in patients with severe congestive heart failure (CHF) and CHF is one of the fastest growing morbidities in western countries. Although peritoneal dialysis (PD) is frequently used in patients with CHF its role remains unclear. Acute chronic volume overload in refractory CHF is still an unresolved clinical problem. In patients with acute heart and renal failure with need of management in an intensive care unit, extracorporeal ultrafiltration or a dialysis modality should be preferred. In patients with chronic refractory CHF, volume overload and renal failure, peritoneal dialysis should be the therapy of choice. Due to the limited data available, treatment and outcome parameters should be recorded in the registry of the German Society of Nephrology (http://www.herz-niere.de).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1

Literatur

  1. http://www.herzinsuffizienz.versorgungsleitlinien.de

  2. K/DOQI clinical practice guidelines for chronic kidney disease (2002): evaluation, classification, and stratification. Am J Kidney Dis 39:1–266

    Article  Google Scholar 

  3. Anavekar NS, McMurray JJ, Velazquez EJ et al (2004) Relation between renal dysfunction and cardiovascular outcomes after myocardial infarction. N Engl J Med 351:1285–1295

    Google Scholar 

  4. 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 46:2043–2046

    Google Scholar 

  5. Bleyer AJ, Hartman J, Brannon PC et al (2006) Characteristics of sudden death in hemodialysis patients. Kidney Int 69:2268–2273

    Article  PubMed  CAS  Google Scholar 

  6. Coca SG, Krumholz HM, Garg AX et al (2006) Underrepresentation of renal disease in randomized controlled trials of cardiovascular disease. JAMA 296:1377–1384

    Article  PubMed  CAS  Google Scholar 

  7. Costanzo MR, Guglin ME, Saltzberg MT et al (2007) Ultrafiltration versus intravenous diuretics for patients hospitalized for acute decompensated heart failure. J Am Coll Cardiol 49:675–683

    Google Scholar 

  8. Damman K, Deursen VM van, Navis G et al (2009) 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 53:582–588

    Google Scholar 

  9. Dasselaar JJ, Slart RH, Knip M et al (2009) Haemodialysis is associated with a pronounced fall in myocardial perfusion. Nephrol Dial Transplant 24:604–610

    Article  PubMed  Google Scholar 

  10. Dickstein K, Cohen-Solal A, Filippatos G et al (2008) ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the diagnosis and treatment of acute and chronic heart failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur J Heart Fail 10:933–989

    Article  PubMed  Google Scholar 

  11. Dikow R, Kihm LP, Zeier M et al (2004) Increased infarct size in uremic rats: reduced ischemia tolerance? J Am Soc Nephrol 15:1530–1536

    Google Scholar 

  12. Doty JM, Saggi BH, Blocher CR et al (2000) Effects of increased renal parenchymal pressure on renal function. J Trauma 48:874–877

    Google Scholar 

  13. Elahi M, Asopa S, Pflueger A et al (2009) Acute kidney injury following cardiac surgery: impact of early versus late haemofiltration on morbidity and mortality. Eur J Cardiothorac Surg 35:854–863

    Article  PubMed  Google Scholar 

  14. Felker GM, Lee KL, Bull DA et al (2011) Diuretic strategies in patients with acute decompensated heart failure. N Engl J Med 364:797–805

    Google Scholar 

  15. Flythe JE, Kimmel SE, Brunelli SM (2011) Rapid fluid removal during dialysis is associated with cardiovascular morbidity and mortality. Kidney Int 79:250–257

    Article  PubMed  Google Scholar 

  16. Heywood JT, Fonarow GC, Costanzo MR et al (2007) 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 13:422–430

    Google Scholar 

  17. Jefferies HJ, Virk B, Schiller B et al (2011) Frequent hemodialysis schedules are associated with reduced levels of dialysis-induced cardiac injury (myocardial stunning). Clin J Am Soc Nephrol 6:1326–1332

    Article  PubMed  Google Scholar 

  18. Marenzi G, Lauri G, Grazi M et al (2001) Circulatory response to fluid overload removal by extracorporeal ultrafiltration in refractory congestive heart failure. J Am Coll Cardiol 38:963–968

    Google Scholar 

  19. McAlister FA, Ezekowitz J, Tonelli M et al (2004) Renal insufficiency and heart failure: prognostic and therapeutic implications from a prospective cohort study. Circulation 109:1004–1009

    Article  PubMed  Google Scholar 

  20. Moist LM, Port FK, Orzol SM et al (2000) Predictors of loss of residual renal function among new dialysis patients. J Am Soc Nephrol 11:556–564

    Google Scholar 

  21. Mullens W, Abrahams Z, Francis GS et al (2009) Importance of venous congestion for worsening of renal function in advanced decompensated heart failure. J Am Coll Cardiol 53:589–596

    Google Scholar 

  22. Mullens W, Abrahams Z, Skouri HN et al (2008) Elevated intra-abdominal pressure in acute decompensated heart failure: a potential contributor to worsening renal function? J Am Coll Cardiol 51:300–306

    Google Scholar 

  23. Nakayama M, Nakano H (2010) Novel therapeutic option for refractory heart failure in elderly patients with chronic kidney disease by incremental peritoneal dialysis. J Cardiol 55:49–54

    Google Scholar 

  24. Nakhoul F, Yigla M, Gilman R et al (2005) The pathogenesis of pulmonary hypertension in haemodialysis patients via arterio-venous access. Nephrol Dial Transplant 20:1686–1692

    Article  PubMed  CAS  Google Scholar 

  25. Neumann T, Biermann J, Neumann A et al (2009) Heart failure: the commonest reason for hospitalization in Germany – medical and economic perspectives. Dtsch Arztebl Int 106:269–275

    PubMed  Google Scholar 

  26. Nohria A, Hasselblad V, Stebbins A et al (2008) Cardiorenal interactions: insights from the ESCAPE trial. J Am Coll Cardiol 51:1268–1274

    Google Scholar 

  27. Nunez J, Gonzalez M, Minana G et al (2012) Continuous ambulatory peritoneal dialysis as a therapeutic alternative in patients with advanced congestive heart failure. Eur J Heart Fail 14:540–548

    Article  PubMed  CAS  Google Scholar 

  28. Parfrey PS, Foley RN, Harnett JD et al (1996) Outcome and risk factors for left ventricular disorders in chronic uraemia. Nephrol Dial Transplant 11:1277–1285

    Article  PubMed  CAS  Google Scholar 

  29. Ronco C, McCullough P, Anker SD et al (2010) Cardio-renal syndromes: report from the consensus conference of the acute dialysis quality initiative. Eur Heart J 31:703–711

    Article  Google Scholar 

  30. Ryckelynck JP, Lobbedez T, Valette B et al (1998) Peritoneal ultrafiltration and treatment-resistant heart failure. Nephrol Dial Transplant 13(Suppl 4):56–59

    Article  PubMed  Google Scholar 

  31. Sanchez JE, Ortega T, Rodriguez C et al (2010) Efficacy of peritoneal ultrafiltration in the treatment of refractory congestive heart failure. Nephrol Dial Transplant 25:605–610

    Article  PubMed  Google Scholar 

  32. Selby NM, McIntyre CW (2011) Peritoneal dialysis is not associated with myocardial stunning. Perit Dial Int 31:27–33

    Article  PubMed  Google Scholar 

  33. Shamseddin MK, Parfrey PS (2009) Mechanisms of the cardiorenal syndromes. Nat Rev Nephrol 5:641–649

    Article  PubMed  Google Scholar 

  34. Stack AG, Molony DA, Rahman NS et al (2003) Impact of dialysis modality on survival of new ESRD patients with congestive heart failure in the United States. Kidney Int 64:1071–1079

    Article  PubMed  Google Scholar 

  35. Testani JM, Khera AV, St John Sutton MG et al (2010) Effect of right ventricular function and venous congestion on cardiorenal interactions during the treatment of decompensated heart failure. Am J Cardiol 105:511–516

    Article  PubMed  Google Scholar 

  36. Wang AY, Wang M, Woo J et al (2004) Inflammation, residual kidney function, and cardiac hypertrophy are interrelated and combine adversely to enhance mortality and cardiovascular death risk of peritoneal dialysis patients. J Am Soc Nephrol 15:2186–2194

    Google Scholar 

  37. Yigla M, Nakhoul F, Sabag A et al (2003) Pulmonary hypertension in patients with end-stage renal disease. Chest 123:1577–1582

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt für sich und seinen Koautor an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

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

    V. Schwenger

  2. Herz- und Gefäßzentrum Bad Bevensen, Bad Bevensen, Deutschland

    A.B. Remppis

Authors
  1. V. Schwenger
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A.B. Remppis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to V. Schwenger.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Schwenger, V., Remppis, A. Nierenersatzverfahren bei therapierefraktärer Herzinsuffizienz. Internist 53, 823–832 (2012). https://doi.org/10.1007/s00108-011-3009-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00108-011-3009-y

Schlüsselwörter

Keywords

Search

Navigation