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Erschienen in: Der Internist 5/2018

28.03.2018 | Herzinsuffizienz | Schwerpunkt: Komorbiditäten bei Herzinsuffizienz

Herz-Nieren-Achse

Beziehung von Herz- und Niereninsuffizienz als Komorbiditäten

verfasst von: M. Zeisberg, Prof. Dr. M. J. Koziolek

Erschienen in: Die Innere Medizin | Ausgabe 5/2018

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Zusammenfassung

Herz- und Niereninsuffizienz treten durch Wirkmechanismen, die in beiden Erkrankungen greifen, häufig gemeinsam auf. Bei Koinzidenz der beiden Erkrankungen verschlechtern sich Verlauf, Symptomatik und Outcome. Therapeutisch ergeben sich Limitierungen durch eine eingeschränkte Evidenzlage bei höhergradiger Niereninsuffizienz, eine häufige Verschlechterung der Nierenfunktion unter Therapie und das Auftreten einer Hyperkaliämie, sodass diese Patientengruppe einer gesteigerten Aufmerksamkeit mit häufigeren Arzt-Patienten-Kontakten bedarf. Eine besondere Herausforderung stellt die sogenannte Diuretikaresistenz dar, die unter Umständen eine extrakorporale Entwässerung nötig macht.
Literatur
1.
Zurück zum Zitat Abraham WT, Zile MR, Weaver FA et al (2015) Baroreflex activation therapy for the treatment of heart failure with a reduced ejection fraction. JACC Heart Fail 3:487–496CrossRefPubMed Abraham WT, Zile MR, Weaver FA et al (2015) Baroreflex activation therapy for the treatment of heart failure with a reduced ejection fraction. JACC Heart Fail 3:487–496CrossRefPubMed
2.
Zurück zum Zitat Bansal N, Katz R, Robinson-Cohen C et al (2017) Absolute rates of heart failure, coronary heart disease, and stroke in chronic kidney disease: an analysis of 3 community-based cohort studies. JAMA Cardiol 2:314–318CrossRefPubMedPubMedCentral Bansal N, Katz R, Robinson-Cohen C et al (2017) Absolute rates of heart failure, coronary heart disease, and stroke in chronic kidney disease: an analysis of 3 community-based cohort studies. JAMA Cardiol 2:314–318CrossRefPubMedPubMedCentral
3.
Zurück zum Zitat 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 46:2043–2046CrossRefPubMed 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 46:2043–2046CrossRefPubMed
4.
Zurück zum Zitat Bart BA, Goldsmith SR, Lee KL et al (2012) Ultrafiltration in decompensated heart failure with cardiorenal syndrome. N Engl J Med 367:2296–2304CrossRefPubMedPubMedCentral Bart BA, Goldsmith SR, Lee KL et al (2012) Ultrafiltration in decompensated heart failure with cardiorenal syndrome. N Engl J Med 367:2296–2304CrossRefPubMedPubMedCentral
5.
Zurück zum Zitat Cohn JN, Tognoni G, Valsartan Heart Failure Trial Investigators (2001) A randomized trial of the angiotensin-receptor blocker valsartan in chronic heart failure. N Engl J Med 345:1667–1675CrossRefPubMed Cohn JN, Tognoni G, Valsartan Heart Failure Trial Investigators (2001) A randomized trial of the angiotensin-receptor blocker valsartan in chronic heart failure. N Engl J Med 345:1667–1675CrossRefPubMed
6.
Zurück zum Zitat Costanzo MR, Saltzberg MT, Jessup M et al (2010) Ultrafiltration is associated with fewer rehospitalizations than continuous diuretic infusion in patients with decompensated heart failure: results from UNLOAD. J Card Fail 16:277–284CrossRefPubMed Costanzo MR, Saltzberg MT, Jessup M et al (2010) Ultrafiltration is associated with fewer rehospitalizations than continuous diuretic infusion in patients with decompensated heart failure: results from UNLOAD. J Card Fail 16:277–284CrossRefPubMed
7.
Zurück zum Zitat Costanzo MR, Negoianu D, Fonarow GC et al (2015) Rationale and design of the aquapheresis versus intravenous diuretics and hospitalization for heart failure (AVOID-HF) trial. Am Heart J 170:471–482CrossRefPubMed Costanzo MR, Negoianu D, Fonarow GC et al (2015) Rationale and design of the aquapheresis versus intravenous diuretics and hospitalization for heart failure (AVOID-HF) trial. Am Heart J 170:471–482CrossRefPubMed
9.
Zurück zum Zitat Desai AS (2009) Hyperkalemia in patients with heart failure: incidence, prevalence, and management. Curr Heart Fail Rep 6:272–280CrossRefPubMed Desai AS (2009) Hyperkalemia in patients with heart failure: incidence, prevalence, and management. Curr Heart Fail Rep 6:272–280CrossRefPubMed
10.
Zurück zum Zitat Ferrari L, Sada S, GrAm (Gruppo di Autoformazione Metodologica) (2015) Efficacy of angiotensin-neprilysin inhibition versus enalapril in patient with heart failure with a reduced ejection fraction. Intern Emerg Med 10:369–371CrossRefPubMed Ferrari L, Sada S, GrAm (Gruppo di Autoformazione Metodologica) (2015) Efficacy of angiotensin-neprilysin inhibition versus enalapril in patient with heart failure with a reduced ejection fraction. Intern Emerg Med 10:369–371CrossRefPubMed
11.
Zurück zum Zitat Filippatos G, Anker SD, Bohm M et al (2016) A randomized controlled study of finerenone vs. eplerenone in patients with worsening chronic heart failure and diabetes mellitus and/or chronic kidney disease. Eur Heart J 37:2105–2114CrossRefPubMedPubMedCentral Filippatos G, Anker SD, Bohm M et al (2016) A randomized controlled study of finerenone vs. eplerenone in patients with worsening chronic heart failure and diabetes mellitus and/or chronic kidney disease. Eur Heart J 37:2105–2114CrossRefPubMedPubMedCentral
12.
Zurück zum Zitat Giglioli C, Landi D, Cecchi E et al (2011) Effects of ULTRAfiltration vs. DIureticS on clinical, biohumoral and haemodynamic variables in patients with deCOmpensated heart failure: the ULTRADISCO study. Eur J Heart Fail 13:337–346CrossRefPubMed Giglioli C, Landi D, Cecchi E et al (2011) Effects of ULTRAfiltration vs. DIureticS on clinical, biohumoral and haemodynamic variables in patients with deCOmpensated heart failure: the ULTRADISCO study. Eur J Heart Fail 13:337–346CrossRefPubMed
13.
Zurück zum Zitat Go AS, Yang JR, Ackerson LM et al (2006) Hemoglobin level, chronic kidney disease, and the risks of death and hospitalization in adults with chronic heart failure – the ANemia in CHronic heart failure: Outcomes and Resource utilization (ANCHOR) study. Circulation 113:2713–2723CrossRefPubMed Go AS, Yang JR, Ackerson LM et al (2006) Hemoglobin level, chronic kidney disease, and the risks of death and hospitalization in adults with chronic heart failure – the ANemia in CHronic heart failure: Outcomes and Resource utilization (ANCHOR) study. Circulation 113:2713–2723CrossRefPubMed
14.
Zurück zum Zitat Group CTS (1987) Effects of enalapril on mortality in severe congestive heart failure. Results of the COoperative North Scandinavian ENalapril SUrvival Study (CONSENSUS). N Engl J Med 316:1429–1435CrossRef Group CTS (1987) Effects of enalapril on mortality in severe congestive heart failure. Results of the COoperative North Scandinavian ENalapril SUrvival Study (CONSENSUS). N Engl J Med 316:1429–1435CrossRef
15.
Zurück zum Zitat Gwoo S, Kim YN, Shin HS et al (2014) Predictors of hyperkalemia risk after hypertension control with aldosterone blockade according to the presence or absence of chronic kidney disease. Nephron Clin Pract 128:381–386CrossRefPubMed Gwoo S, Kim YN, Shin HS et al (2014) Predictors of hyperkalemia risk after hypertension control with aldosterone blockade according to the presence or absence of chronic kidney disease. Nephron Clin Pract 128:381–386CrossRefPubMed
16.
Zurück zum Zitat Hatamizadeh P, Fonarow GC, Budoff MJ et al (2013) Cardiorenal syndrome: pathophysiology and potential targets for clinical management. Nat Rev Nephrol 9:99–111CrossRefPubMed Hatamizadeh P, Fonarow GC, Budoff MJ et al (2013) Cardiorenal syndrome: pathophysiology and potential targets for clinical management. Nat Rev Nephrol 9:99–111CrossRefPubMed
17.
Zurück zum Zitat Investigators S, Yusuf S, Pitt B et al (1992) Effect of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left ventricular ejection fractions. N Engl J Med 327:685–691CrossRef Investigators S, Yusuf S, Pitt B et al (1992) Effect of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left ventricular ejection fractions. N Engl J Med 327:685–691CrossRef
18.
Zurück zum Zitat Kazory A (2017) Fluid overload as a major target in management of cardiorenal syndrome: implications for the practice of peritoneal dialysis. World J Nephrol 6:168–175CrossRefPubMedPubMedCentral Kazory A (2017) Fluid overload as a major target in management of cardiorenal syndrome: implications for the practice of peritoneal dialysis. World J Nephrol 6:168–175CrossRefPubMedPubMedCentral
19.
Zurück zum Zitat Kosiborod M, Rasmussen HS, Lavin P et al (2014) Effect of sodium zirconium cyclosilicate on potassium lowering for 28 days among outpatients with hyperkalemia: the HARMONIZE randomized clinical trial. JAMA 312:2223–2233CrossRefPubMed Kosiborod M, Rasmussen HS, Lavin P et al (2014) Effect of sodium zirconium cyclosilicate on potassium lowering for 28 days among outpatients with hyperkalemia: the HARMONIZE randomized clinical trial. JAMA 312:2223–2233CrossRefPubMed
20.
Zurück zum Zitat Lechat P, Brunhuber KW, Hofmann R et al (1999) The Cardiac Insufficiency BIsoprolol Study II (CIBIS-II): a randomised trial. Lancet 353:9–13CrossRef Lechat P, Brunhuber KW, Hofmann R et al (1999) The Cardiac Insufficiency BIsoprolol Study II (CIBIS-II): a randomised trial. Lancet 353:9–13CrossRef
21.
Zurück zum Zitat Lofman I, Szummer K, Dahlstrom U et al (2017) Associations with and prognostic impact of chronic kidney disease in heart failure with preserved, mid-range, and reduced ejection fraction. Eur J Heart Fail 19:1606–1614CrossRefPubMed Lofman I, Szummer K, Dahlstrom U et al (2017) Associations with and prognostic impact of chronic kidney disease in heart failure with preserved, mid-range, and reduced ejection fraction. Eur J Heart Fail 19:1606–1614CrossRefPubMed
22.
Zurück zum Zitat Lu R, Mucino-Bermejo MJ, Ribeiro LC et al (2015) Peritoneal dialysis in patients with refractory congestive heart failure: a systematic review. Cardiorenal Med 5:145–156CrossRefPubMedPubMedCentral Lu R, Mucino-Bermejo MJ, Ribeiro LC et al (2015) Peritoneal dialysis in patients with refractory congestive heart failure: a systematic review. Cardiorenal Med 5:145–156CrossRefPubMedPubMedCentral
23.
Zurück zum Zitat Marenzi G, Muratori M, Cosentino ER et al (2014) Continuous ultrafiltration for congestive heart failure: the CUORE trial. J Card Fail 20:9–17CrossRefPubMed Marenzi G, Muratori M, Cosentino ER et al (2014) Continuous ultrafiltration for congestive heart failure: the CUORE trial. J Card Fail 20:9–17CrossRefPubMed
24.
Zurück zum Zitat McAlister FA, Ezekowitz J, Tarantini L et al (2012) Renal dysfunction in patients with heart failure with preserved versus reduced ejection fraction: impact of the new chronic kidney disease-epidemiology collaboration group formula. Circ Heart Fail 5:309–314CrossRefPubMed McAlister FA, Ezekowitz J, Tarantini L et al (2012) Renal dysfunction in patients with heart failure with preserved versus reduced ejection fraction: impact of the new chronic kidney disease-epidemiology collaboration group formula. Circ Heart Fail 5:309–314CrossRefPubMed
25.
Zurück zum Zitat McMurray JJ, Ostergren J, Swedberg K et al (2003) Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function taking angiotensin-converting-enzyme inhibitors: the CHARM-added trial. Lancet 362:767–771CrossRefPubMed McMurray JJ, Ostergren J, Swedberg K et al (2003) Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function taking angiotensin-converting-enzyme inhibitors: the CHARM-added trial. Lancet 362:767–771CrossRefPubMed
26.
Zurück zum Zitat McMurray JJ, Packer M, Desai AS et al (2014) Angiotensin-neprilysin inhibition versus enalapril in heart failure. N Engl J Med 371:993–1004CrossRefPubMed McMurray JJ, Packer M, Desai AS et al (2014) Angiotensin-neprilysin inhibition versus enalapril in heart failure. N Engl J Med 371:993–1004CrossRefPubMed
27.
Zurück zum Zitat Pitt B, Zannad F, Remme WJ et al (1999) The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized aldactone evaluation study investigators. N Engl J Med 341:709–717CrossRefPubMed Pitt B, Zannad F, Remme WJ et al (1999) The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized aldactone evaluation study investigators. N Engl J Med 341:709–717CrossRefPubMed
28.
Zurück zum Zitat Pitt B, Anker SD, Bushinsky DA et al (2011) Evaluation of the efficacy and safety of RLY5016, a polymeric potassium binder, in a double-blind, placebo-controlled study in patients with chronic heart failure (the PEARL-HF) trial. Eur Heart J 32:820–828CrossRefPubMedPubMedCentral Pitt B, Anker SD, Bushinsky DA et al (2011) Evaluation of the efficacy and safety of RLY5016, a polymeric potassium binder, in a double-blind, placebo-controlled study in patients with chronic heart failure (the PEARL-HF) trial. Eur Heart J 32:820–828CrossRefPubMedPubMedCentral
29.
Zurück zum Zitat Ponikowski P, Filippatos G, Colet JC et al (2015) The impact of intravenous ferric carboxymaltose on renal function: an analysis of the FAIR-HF study. Eur J Heart Fail 17:329–339CrossRefPubMedPubMedCentral Ponikowski P, Filippatos G, Colet JC et al (2015) The impact of intravenous ferric carboxymaltose on renal function: an analysis of the FAIR-HF study. Eur J Heart Fail 17:329–339CrossRefPubMedPubMedCentral
30.
Zurück zum Zitat Ponikowski P, Voors AA, Anker SD et al (2016) 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC ). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 37:2129–2200CrossRefPubMed Ponikowski P, Voors AA, Anker SD et al (2016) 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC ). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 37:2129–2200CrossRefPubMed
31.
Zurück zum Zitat Ponikowski P, Voors AA, Anker SD et al (2016) 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 18:891–975CrossRefPubMed Ponikowski P, Voors AA, Anker SD et al (2016) 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 18:891–975CrossRefPubMed
32.
Zurück zum Zitat Redfield MM (2016) Heart failure with preserved ejection fraction. N Engl J Med 375:1868–1877CrossRefPubMed Redfield MM (2016) Heart failure with preserved ejection fraction. N Engl J Med 375:1868–1877CrossRefPubMed
33.
Zurück zum Zitat Ronco C, Haapio M, House AA et al (2008) Cardiorenal syndrome. J Am Coll Cardiol 52:1527–1539CrossRefPubMed Ronco C, Haapio M, House AA et al (2008) Cardiorenal syndrome. J Am Coll Cardiol 52:1527–1539CrossRefPubMed
34.
Zurück zum Zitat Saran R, Robinson B, Abbott KC et al (2017) US renal data system 2016 annual data report: epidemiology of kidney disease in the United States. Am J Kidney Dis 69:A7–A8CrossRefPubMed Saran R, Robinson B, Abbott KC et al (2017) US renal data system 2016 annual data report: epidemiology of kidney disease in the United States. Am J Kidney Dis 69:A7–A8CrossRefPubMed
35.
Zurück zum Zitat Scrutinio D, Agostoni P, Gesualdo L et al (2015) Renal function and peak exercise oxygen consumption in chronic heart failure with reduced left ventricular ejection fraction. Circ J 79:583–591CrossRefPubMed Scrutinio D, Agostoni P, Gesualdo L et al (2015) Renal function and peak exercise oxygen consumption in chronic heart failure with reduced left ventricular ejection fraction. Circ J 79:583–591CrossRefPubMed
36.
Zurück zum Zitat Testani JM, Coca SG, Shannon RP et al (2011) Influence of renal dysfunction phenotype on mortality in the setting of cardiac dysfunction: analysis of three randomized controlled trials. Eur J Heart Fail 13:1224–1230CrossRefPubMedPubMedCentral Testani JM, Coca SG, Shannon RP et al (2011) Influence of renal dysfunction phenotype on mortality in the setting of cardiac dysfunction: analysis of three randomized controlled trials. Eur J Heart Fail 13:1224–1230CrossRefPubMedPubMedCentral
38.
Zurück zum Zitat Weir MR, Bakris GL, Bushinsky DA et al (2015) Patiromer in patients with kidney disease and hyperkalemia receiving RAAS inhibitors. N Engl J Med 372:211–221CrossRefPubMed Weir MR, Bakris GL, Bushinsky DA et al (2015) Patiromer in patients with kidney disease and hyperkalemia receiving RAAS inhibitors. N Engl J Med 372:211–221CrossRefPubMed
39.
Zurück zum Zitat Yilmaz MB, Gayat E, Salem R et al (2011) Impact of diuretic dosing on mortality in acute heart failure using a propensity-matched analysis. Eur J Heart Fail 13:1244–1252CrossRefPubMed Yilmaz MB, Gayat E, Salem R et al (2011) Impact of diuretic dosing on mortality in acute heart failure using a propensity-matched analysis. Eur J Heart Fail 13:1244–1252CrossRefPubMed
40.
Zurück zum Zitat Zannad F, McMurray JJ, Krum H et al (2011) Eplerenone in patients with systolic heart failure and mild symptoms. N Engl J Med 364:11–21CrossRefPubMed Zannad F, McMurray JJ, Krum H et al (2011) Eplerenone in patients with systolic heart failure and mild symptoms. N Engl J Med 364:11–21CrossRefPubMed
41.
Zurück zum Zitat Zinman B, Wanner C, Lachin JM et al (2015) Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med 373:2117–2128CrossRefPubMed Zinman B, Wanner C, Lachin JM et al (2015) Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med 373:2117–2128CrossRefPubMed
Metadaten
Titel
Herz-Nieren-Achse
Beziehung von Herz- und Niereninsuffizienz als Komorbiditäten
verfasst von
M. Zeisberg
Prof. Dr. M. J. Koziolek
Publikationsdatum
28.03.2018
Verlag
Springer Medizin
Erschienen in
Die Innere Medizin / Ausgabe 5/2018
Print ISSN: 2731-7080
Elektronische ISSN: 2731-7099
DOI
https://doi.org/10.1007/s00108-018-0410-9

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