66 Acute Decompensated Heart Failure National Registry (ADHERE) 30% (10%) 2 31% <30mL/ min %( 0.3mg/dl) % 6 ( ) ( ) 7 Mullens (

Transcription

1 專題報導 摘 要 (Cardiorenal syndrome) (Heart failure) (Acute kidney injury) (Chronic kidney disease) (cardiorenal syndrome) 2008 Ronco ( )

2 66 Acute Decompensated Heart Failure National Registry (ADHERE) 30% (10%) 2 31% <30mL/ min %( 0.3mg/dl) % 6 ( ) ( ) 7 Mullens ( ) β1-to-β2 ( ) - - (renin-angiotensin-aldosterone system) galectin-3 procollagen I procollagen III II ( ) (anti-diuretic hormone, arginine vasopressin) V1 V2 ( ) (adenosine) 9 (natriuretic peptide) II (tumour necrosis factor) interleukin-1 interleukin-6 interleukin-8-1(monocyte chemoattractant protein-1) (superoxide) 10

3 67 (nitric oxide) (hepcidin) 11 ( ) (mineral bone disease) D D (calcitriol) II 10 Chen D 12 FGF23 (fibroblast growth factor 23) FGF23 13 FGF23 14 FGF23 FGF FGF23 FGF23 ( ) (biomarker) (biomarker) neutrophil gelatinase associated lipocalin (NGAL) kidney injury molecule-1(kim-1) IL-18 IL-6 cystatin C N-acetyl-d-glucosamide liver-type fatty acid-binding protein (L-FABP) Klotho Midkine cardiac troponin T (ctnt) I (ctni) B-type natriuretic peptide (BNP) inactive N-terminal fragment (NT-proBNP) 15 loop diuretics

4 68 thiazide Vasopressin V2-receptor antagonists tolvaptan 16 ( slow continuous ultrafiltration (SCUF)) ( continuous veno-venous hemofiltration (CVVH)) ( ) (nitrates) nitroglycerin nitroprusside Nesiritide ( ) dobutamine dopamine milrinone levosimendan ( ) istaroxime ( ) ( ) A1 (adenosine A1-receptor antagonists) rolofylline loop ( ) (β-blockers) ( ) - - (reninangiotensin-aldosterone system) ACE (angiotensin-converting-enzyme inhibitors ACEi) (aldosteronereceptor blockers ARB) ( ) (kidney sympathetic denervation) (erythropoiesisstimulating agents, ESAs) 20

5 69 1. Ronco C, Haapio M, House AA, Anavekar N, Bellomo R. Cardiorenal syndrome. J Am Coll Cardiol 2008; 52: Adams KF Jr, Fonarow GC, Emerman CL, et al. Characteristics and outcomes of patients hospitalized for heart failure in the United States: rationale, design, and preliminary observations from the first 100,000 cases in the Acute Decompensated Heart Failure National Registry(ADHERE) Am Heart J 2005; 149: McAlister FA, Ezekowitz J, Tonelli M, Armstrong PW. Renal insufficiency and heart failure: prognostic and therapeutic implications from a prospective cohort study. Circulation 2004; 109: Ronco C, Chionh CY, Haapio M, Anavekar NS, House A, Bellomo R. The cardiorenal syndrome. Blood Purif 2009; 27: McCullough P Ronco C, Anker SD, Anand I, Aspromonte N, Bagshaw SM, Bellomo R, Berl T, Bobek I, Cruz DN, Daliento L, Davenport A, Haapio M, Hillege H, House AA, Katz N, Maisel A, Mankad S, Zanco P, Mebazaa A, Palazzuoli A, Ronco F, Shaw A, Sheinfeld G, Soni S, Vescovo G, Zamperetti N, Ponikowski P. Cardio-renal syndromes: report from the consensus conference of the Acute Dialysis Quality Initiative. Eur Heart J 2010; 31: Hsieh MJ, Chen YC, Chen CC, Wang CL, Wu LS, Wang CC. Renal dysfunction on admission, worsening renal function, and severity of acute kidney injury predict 2-year mortality in patients with acute myocardial infarction. Circ J 2012; 77: Firth JD, Raine AE, Ledingham JG. Raised venous pressure: a direct cause of renal sodium retention in oedema? Lancet 1988; 1: 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: Vallon V, Miracle C, Thomson S. Adenosine and kidney function: potential implications in patients with heart failure. Eur J Heart Fail 2008; 10: Hatamizadeh P, Fonarow GC, Budoff MJ, Darabian S, Kovesdy CP, Kalantar-Zadeh K. Cardiorenal syndrome: pathophysiology and potential targets for clinical management. Nat Rev Nephrol 2013; 9: Young B, Zaritsky J. Hepcidin for clinicians. Clin J Am Soc Nephrol 2009; 4: Chen S, Law CS, Grigsby CL, et al. Cardiomyocyte-specific deletion of the vitamin D receptor gene results in cardiac hypertrophy. Circulation 2011; 124: Jüppner H. Phosphate and FGF-23. Kidney Int Suppl 2011; 79: S24-S Plischke M, Neuhold S, Adlbrecht C, et al. Inorganic phosphate and FGF-23 predict outcome in stable systolic heart failure. Eur J Clin Invest 2012; 42: Anan C, John AK. Cardio-Renal Syndrome Type 3: Epidemiology, Pathophysiology, and Treatment. Semin Nephrol 2012; 32: Konstam MA, Gheorghiade M, Bumett JC, et al. Effects of oral tolvaptan in patients hospitalized for worsening heart failure: the EVEREST Outcome Trial. JAMA 2007; 297: Givertz MM, Massie BM, Fields TK, Pearson LL, Dittrich HC, CKI-201 and CKI-202 Investigators. The effects of KW-3902, an adenosine A1-receptor antagonist, on diuresis and renal function in patients with acute decompensated heart failure and renal impairment or diuretic resistance. J Am Coll Cardiol 2007: Massie BM, O'Connor CM, Metra M, et al. Rolofylline, an adenosine A1-receptor antagonist, in acute heart failure N Engl J Med 2010; 363: Bock JS, Gottlieb SS. Cardiorenal syndrome: new perspectives. Circulation 2010; 121: Burger D, Xenocostas A, Feng QP. Molecular basis of cardioprotection by erythropoietin. Curr Mol Pharmacol 2009; 2:

6 70 Cardiorenal Syndrome and Management Pei-Chun Fan, Chih-Hsiang Chang, and Yung-Chang Chen Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan In recent decades, the idea of organ cross-talk has been increasingly appreciated in human diseases, with cardiorenal syndrome being a typical example. The cardiorenal syndrome is defined as disorders of the heart and kidneys whereby acute or chronic dysfunction in one organ may induce acute or chronic dysfunction of the other. In terms of the primary dysfunctional organ and the time-frame, it is further divided into five subtypes. The pathophysiology of cardiorenal syndrome is extremely complex and has not been fully understood. The scenario of cardiorenal syndrome involves hemodynamic alterations, sympathetic nervous system activation, renin-angiotensin-aldosterone system activation, inflammation reaction and oxidative stress, endothelial dysfunction, anemia, etc. Meanwhile, renal failure related uremic toxins, electrolyte imbalance, acidosis, mineral-bone-disease also play important roles. Aside from traditional therapy for heart failure,known supportive treatment for renal failure or renal replacement therapy, novel therapies are being developed targeting underlying pathologies. (J Intern Med Taiwan 2014; 25: 65-70)