Российское диализное общество

Просмотр статьи

<< Вернуться к списку статей журнала

Том 20 №3 2018 год - Нефрология и диализ

Кардиоренальный синдром у больных на заместительной почечной терапии (Обзор литературы)


Шутов Е.В. Николаев А.Ю. Филатова Н.Н.

DOI: 10.28996/2618-9801-2018-3-262-273

Аннотация: В представленном обзоре обсуждаются кардиоренальные взаимоотношения у больных на заместительной почечной терапии (ЗПТ), которые рассматриваются как отдельный тип кардиоренального синдрома (КРС) - диализный КРС, где под ренальным компонентом подразумеваются комплекс метаболических и эндокринных нарушений, осложняющих терминальную уремию, остаточная функция почек и собственно диализная терапия. В обзоре анализируется ассоциированная с ЗПТ кардиальная дисфункция и обсуждаются патогенетические механизмы кардиоренальных взаимоотношений у больных на ЗПТ: снижение эффективности диализа, утрата остаточной функции почек, биосовместимость диализных мембран, окислительный стресс и хроническое воспаление, белково-энергетическая недостаточность и диализная кахексия, влияние артерио-венозной фистулы. Среди причин прогрессирующей ишемии миокарда у диализных больных выделяют синдром "оглушения миокарда", интрадиализную гипотензию, уремическое поражение мелких ветвей коронарных артерий. Профилактика диализного КРС включает выбор оптимального метода ЗПТ (гемодиализ или перитональный диализ), стандартизацию диализного режима с контролем остаточной функции почек и интрадиализной гипотензии, применение биосовместимых мембран и растворов, лечение белково-энергетической недостаточности, контроль уровня фосфата, кальция, паратиреоидного гормона, фактора роста фибробластов-23, C-реактивного протеина и фактора некроза опухоли-альфа, индекса массы тела, альбумина, гемоглобина. Также приводятся данные по использованию кардиопротективной фармакотерапии, ангиопластики и имплантации водителя ритма.

Весь текст

Ключевые слова: гемодиализ, перитонеальный диализ, кардиоренальный синдром, остаточная функция почек, белково-энергетическая недостаточность, оксидативный стресс, артерио-венозная фистула, интрадиализная гипотензия, коронарный атеросклероз, застойная сердечная недостаточность, hemodialysis, peritoneal dialysis, cardiorenal syndrome, residual renal function, arterio-venous hemodialysis fistula, malnutrition, oxidative stress, hemodialysis-induced hypotension, coronary atherosclerosis, congestive heart failure

Список литературы:
  1. Ronco C. Cardiorenal syndromes: definition and classification. Contrib. Nephrol. 2010; 164: 33-8.
  2. Кобалава Ж.Д., Ефремовцева М.А., Виллевальде С.В. Кардиоренальные синдромы. Клиническая нефрология. 2011; 6: 9-15.
  3. Vanholder R., Massy Z., Argiles A. al. Chronic kidney disease as a cause of cardiovascular morbidity and mortality. Nephrol Dial Transplant. 2005; 20(6): 1048-56.
  4. Zoccalli C. Cardiorenal risk as a new frontier of nephrology: research needs and areas for intervention. Nephrol Dial Transplant. 2002; 17 Suppl 11: 50-4.
  5. London G.M., Marchais S.J., Guerin A.P. et al. Inflammation, arteriosclerosis, and cardiovascular therapy in hemodialysis patients. Kidney Int Suppl. 2003; 84: S88-93.
  6. Libetta C, Sepe V, Esposito P.et al. Oxidative stress and inflammation: implications in uremia and hemodialysis. Clin Biochem. 2011; 44(14-15): 1189-98.
  7. Mares J., Richtrova P., Hricinova A. et al. Proteomic profiling of blood-dialyzer interactome reveals involvement of lectin complement pathway in hemodialysis-induced inflammatory response. Proteomics Clin Appl. 2010; 4(10-11): 829-38.
  8. Brunini T.M., Mendes-Ribeiro A.C., Ellory J.C., Mann G.E. Platelet nitric oxide syn-thesis in uremia and malnutrition: a role for L-arginine supplementation in vascular protection? Cardiovasc Res. 2007; 73(2): 359-67.
  9. Locatelli F., Del Vecchio L., Pozzoni P., Andrulli S. Dialysis adequacy and response to erythropoiesis-stimulating agents: what is the evidence base? Semin Nephrol. 2006; 26(4): 269-74.
  10. Elliott J., Mishler D., Agarwal R. Hyporesponsiveness to erythropoietin: causes and management. Adv Chronic Kidney Dis. 2009; 16(2): 94-100.
  11. Van der Steen A. Research on dialyzers with improved biocompatibility. Clin Nephrol. 1986; 26 Suppl 1: S39-42.
  12. Rousseau Y., Carreno M.P., Poignet J.L. et al. Dissociation between complement activation, integrin expression and neutropenia during hemodialysis. Biomaterials. 1999; 20(20): 1959-67.
  13. Del Vecchio L., Locatelli F., Carini M. What we know about oxidative stress in patients with chronic kidney disease on dialysis - clinical effects, potential treatment, and prevention. Semin Dial. 2011; 24(1): 56-64.
  14. Jansen M.A., Hart A.A., Korevaar J.C. et al. Рredictors of the rate of decline of residual renal function in incident dialysis patients. Kidney Int. 2002; 62(3): 1046-53.
  15. Ikizler T.A., Morrow J.D., Roberts L.J. et al. Plasma F2-isoprostane levels are elevated in chronic hemodialysis patients. Clin Nephrol. 2002; 58(3): 190-7.
  16. Ferraro B., Galli F., Frei B. et al. Peroxynitrite-induced oxidation of plasma lipids is enhanced in stable hemodialysis patients. Kidney Int. 2003; 63(6): 2207-13.
  17. Muller C., Eisenbrand G., Gradinger M. et al. Effects of hemodialysis, dialyser type and iron infusion on oxidative stress in uremic patients. Free Radic Res. 2004; 38(10): 1093-100.
  18. Galli F., Benedetti S., Floridi A. et al. Glycoxidation and inflammatory markers in pa-tients on treatment with PMMA-based protein-leaking dialyzers. Kidney Int. 2005; 67(2): 750-9.
  19. Piroddi M., Palmese A., Pilolli F. et al. Plasma nitroproteome of kidney disease patients. Amino Acids. 2011; 40(2): 653-67.
  20. Thornalley P.J., Rabbani N. Protein damage in diabetes and uremia - identifying hot-spots of proteome damage where minimal modification is amplified to marked pathophysiological effect. Free Radic Res. 2011; 45(1): 89-100.
  21. Vanholder R., Baurmeister U., Brunet P. et al. A bench to bedside view of uremic toxins. J Am Soc Nephrol. 2008; 19(5): 863-70.
  22. Vanholder R., Schepers E., Meert N., Lameire N. What is uremia? Retention versus oxidation. Blood Purif. 2006; 24(1): 33-8.
  23. De Smet R., Dhondt A., Eloot S.et al. Effect of the super-flux cellulose triacetate dialyser membrane on the removal of non-protein-bound and protein-bound uraemic solutes. Nephrol Dial Transplant. 2007; 22(7): 2006-12.
  24. Thomas G., Jaber B.L. Convective therapies for removal of middle molecular weight uremic toxins in end-stage renal disease: a review of the evidence. Semin Dial. 2009; 22(6): 610-4.
  25. Galli F., Piroddi M., Annetti C. et al. Oxidative stress and reactive oxygen species. Contrib Nephrol. 2005; 149: 240-60.
  26. Sanchez-Lozada L.G., Tapia E., Johnson R.J. et al. Glomerular hemodynamic changes associated with arteriolar lesions and tubulointerstitial inflammation. Kidney Int Suppl. 2003; 86: S9-14.
  27. Niijima A., Hori T., Aou S., Oomura Y. The effects of interleukin-1β on the activity of adrenal, splenic and renal sympathetic nerves in the rat. J Auton Nerv Syst. 1991; 36(3): 183-92.
  28. Wassmann S., Stumpf M., Strehlow K. et al. Interleukin-6 induces oxidative stress and endothelial dysfunction by overexpression of the angiotensin II type 1 receptor. Circ Res. 2004; 94(4): 534-41.
  29. Tsutamoto T., Hisanaga T., Wada A. et al. Interleukin-6 spillover in the peripheral circulation increases with the severity of heart failure, and the high plasma level of interleukin-6 is an important prognostic predictor in patients with congestive heart failure. J Am Coll Cardiol. 1998; 31(2): 391-8.
  30. Anker S.D., Egerer K.R., Volk H.D. et al. Elevated soluble CD14 receptors and altered cytokines in chronic heart failure. Am J Cardiol. 1997; 79: 1426-30.
  31. Kawai M., Naruse K., Komatsu S. et al. Mechanical stress-dependent secretion of interleukin-6 by endothelial cells after portal vein embolization: clinical and experimental studies. J Hepatol. 2002; 37(2): 240-6.
  32. Gama-Axelsson T., Heimburger D., Stevinkel P. et al. Serum albumin as predictor of nutritional status in patients with ESRD. Clin J Am Soc Nephrol. 2012; 7(9): 1446-53.
  33. Carrero J.J., Avesani C.M. Pros and cons of body mass index as a nutritional and risk assessment tool in dialysis patients. Semin Dial. 2015; 28(1): 48-58.
  34. Kovesdy C.P. Malnutrition in Dialysis patients - the need for intervention despite uncertain benefits. Semin Dial. 2016; 29(1): 28-34.
  35. Kalantar-Zadeh K., Ikizler T.A., Block G. et al. Malnutrition-Inflammation complex syndrome in dialysis patients: causes and consequences. Am J Kidney Dis. 2003; 42(5): 864-81.
  36. De Roij van Zuijdewijn C.L., ter Wee P.M., Chapdelaine I. et al. A comparison of 8 nutrition-related tests to predict mortality in haemodialysis patients. J Ren Nutr. 2015; 25(5): 412-19.
  37. Termorshuizen F., Dekker F.W., van Manen J.G. et al. Relative contribution of residual renal function and different measures of adequacy to survival in hemodialysis patients: an analysis of the Netherlands Cooperative Study on the Adequacy of Dialysis (NE-COSAD)-2. J Am Soc Nephrol. 2004; 15(4): 1061-70.
  38. Van der Wal W.M., Noordzij M., Dekker F.W. et al. Full loss of residual renal function causes higher mortality in dialysis patients; findings from a marginal structural model. Nephrol Dial Transplant. 2011; 26(9): 2978-83.
  39. Obi Y., Streja E., Rhee C. et al. Incremental hemodialysis, residual kidney function, and mortality risk in incident dialysis patients: A Cohort Study. Am J Kidney Dis. 2016; 68(2): 256-65.
  40. Diaz-Buxo J.A., Lowrie E.G., Lew N.L. et al. Associates of mortality among peritoneal dialysis patients with special reference to peritoneal transport rates and solute clearance. Am J Kidney Dis. 1999; 33(3): 523-34.
  41. Rocco M., Soucie J.M., Pastan S., McClellan W.M. Peritoneal dialysis adequacy and risk of death. Kidney Int. 2000; 58(1): 446-57.
  42. Bargman J.M., Thorpe K.E., Churchill D.N., Group CPDS Relative contribution of re-sidual renal function and peritoneal clearance to adequacy of dialysis: a reanalysis of the CANUSA study. J Am Soc Nephrol. 2001; 12(10): 2158-62.
  43. Kabanda A., Jadoul M., Pochet J.M.et al. Determinants of the serum concentrations of low molecular weight proteins in patients on maintenance hemodialysis. Kidney Int. 1994; 45(6): 1689-96.
  44. Stompór T., Sułowicz W., Anyszek T. et al. Dialysis adequacy, residual renal function and serum concentrations of selected low molecular weight proteins in patients undergoing continuous ambulatory peritoneal dialysis. Med Sci Monit. 2003; 9(11): CR500-504.
  45. Delaney M.P., Stevens P.E., Al Hasani M. et al. Relationship of serum cystatin C to peritoneal and renal clearance measures in peritoneal dialysis: a cross-sectional study. Am J Kidney Dis. 2008; 51(2): 278-84.
  46. Gunal AI., Kirciman E., Guler M., Yavuzkir M., Celiker H. Should the preservation of residual renal function cost volume overload and its consequence left ventricular hypertrophy in new hemodialysis patients? Ren Fail. 2004; 26(4): 405-409.
  47. Voroneanu L., Cusai C., Hogas S. et al. The relationship between chronic volume overload and elevated blood pressure in hemodialysis patients: Use of bioimpedance provides a different perspective from echocardiography and biomarker methodologies. International Urology and Nephrology. 2010; 42(3): 789-97.
  48. Hassan K., Hassan S., Anwar S. et al. Predictors of left ventricular hypertrophy and their cutoffs in peritoneal dialysis patients. Int Heart J. 2015; 56(2): 186-91.
  49. McIntyre C.W., Burton J.O., Selby N.M. et al. Hemodialysis-induced cardiac dysfunction is associated with an acute reduction in global and segmental myocardial blood flow. Clin J Am Soc Nephrol. 2008; 3(1): 19-26.
  50. Burton J.O., Jefferies H.J., Selby N.M., McIntyre C.W. Hemodialysis-induced repetitive myocardial injury results in global and segmental reduction in systolic cardiac function. Clin J Am Soc Nephrol. 2009; 4(12): 1925-31.
  51. Burton J.O., Jefferies H.J., Selby N.M., McIntyre C.W. Hemodialysis-induced cardiac injury: determinants and associated outcomes. Clin J Am Soc Nephrol. 2009; 4(5): 914-20
  52. Dorairajan S., Chockalingam A., Misra M. Myocardial stunning in hemodialysis: what is the overall message? Hemodial Int. 2010; 14(4): 447-50.
  53. McIntyre C.W. Haemodialysis-induced myocardial stunning in chronic kidney disease - a new aspect of cardiovascular disease. Blood Purif. 2010; 29(2): 105-10.
  54. Shafi T., Jaar B.G., Plantinga L.C. et al. Association of residual urine output with mor-tality, quality of life, and inflammation in incident hemodialysis patients: the Choices for healthy outcomes in caring for end-stage renal disease (CHOICE) Study. Am J Kidney Dis. 2010; 56(2): 348-58.
  55. Suda T., Hiroshige K., Ohta T. et al. The contribution of residual renal function to overall nutritional status in chronic haemodialysis patients. Nephrol Dial Transplant. 2000; 15(3): 396-401.
  56. Vilar E., Wellsted D., Chandna S.M., Greenwood R.N., Farrington K. Residual renal function improves outcome in incremental haemodialysis despite reduced dialysis dose. Nephrol Dial Transplant. 2009; 24(8): 2502-10.
  57. Penne E.L., van der Weerd N.C., Grooteman M.P. et al. Role of residual renal function in phosphate control and anemia management in chronic hemodialysis patients. Clin J Am Soc Nephrol. 2011; 6(2): 281-9.
  58. Wang A.Y., Wang M., Woo J. et al. Inflammation, residual kidney function, and cardiac hypertrophy are interrelated and combine adversely to enhance mortality and сardiovascular death risk of peritoneal dialysis patients. J. Am. Soc. Nephrol. 2004; 15(8): 2186-94.
  59. Palomo-Piñón S., Mora-Villalpando C.J., Del Carmen Prado-Uribe M. et al. Inflammation and myocardial damage markers influence loss of residual renal function in peritoneal dialysis patients. Arch Med Res. 2014; 45(6): 484-8.
  60. Selby N.M., McIntyre C.W. Peritoneal dialysis is not associated with myocardial stunning. Perit Dial Int. 2011; 31(1): 27-33.
  61. Panday V.B., Tong Z.P., Ng P.L. et al. Dialysis modality and 2-year outcomes in patients with ischemic cardiomyopathy and end-stage renal disease. Int J Cardiol. 2014; 176(3): 1097-9.
  62. Wang I.K., Kung P.T., Kuo W.Y. et al. Impact of dialysis modality on the survival of end-stage renal disease patients with or without cardiovascular disease. J Nephrol. 2013; 26(2): 331-41.
  63. Locatelli F., Marcelli D., Conte F. et al. Survival and development of cardiovascular disease by modality of treatment in patients with end-stage renal disease. J Am Sоc Nephrol. 2001; 12(11): 2411-7.
  64. Wang I.K., Lu C.Y., Lin C.L.et al. Comparison of the risk of de novo cardiovascular disease between hemodialysis and peritoneal dialysis patients with end-stage renal disease. Int J Cardiol. 2016; 218: 219-24.
  65. Cтроков А.Г., Гуревич К.Я., Денисов А.Ю. Лечение пациентов хронической бо-лезнью почек 5-й стадии методом гемодиализа. В: Нефрология. Клинические ре-комендации. Под ред. Е.М. Шилов, А.В. Смирнов, Н.Л. Козловская. М.: "Гэотар-Медиа". 2016: 633-55.
  66. Stevinkel P. C-reactive protein: does it promote vascular disease? Nephrol. Dial. Transplant. 2006; 21(10): 2718-20.
  67. Amann K., Ritz C., Adamczak M, Ritz E. Why is coronary heart disease of uraemic patients so frequent and so devastating? Nephrol Dial Transplant. 2003; 18(4): 631-40.
  68. Goodman W., Goldin J., Kuizon B.D. et al. Coronary-artery calcification in young adults with ESRD who are undergoing dialysis. New Engl J Med. 2000; 342(20): 1478-83.
  69. Barreto D.V., Barreto F.C., Carvalho A.B. et al. Coronary calcification in hemodialysis patients: the contribution of traditional and uremia-related risk factors. Kidney Int. 2005; 67(4): 1576-82.
  70. Charytan D., Kuntz R.E., Mauri L., DeFilippi C. Distribution of coronary artery disease and relation to mortality in asymptomatic hemodialysis patients. Am J Kidney Dis. 2007; 49(3): 409-16.
  71. McCullough P.A., Sandberg K.P., Yee J., Hudson MP. Mortality benefit of angionensin-converting enzyme inhibitors after cardiac events in patients with ESRD. J Renin Angiotensin Aldosterone Syst. 2002; 3(3): 188-91.
  72. Baber U., Toto R.D., de Lemos J.A. Statins and cardiovascular risk reduction in pa-tients with chronic kidney disease and ESRD. Am Heart Dis. 2007; 153(4): 471-7.
  73. Liu J.Y., Birkmeyer N.J., Sanders J.H. et al. Risks of morbidity and mortality in dialysis patients undergoing coronary artery bypass surgery. Circulation. 2000; 102(24): 2973-7.
  74. US Renal Data System USRDS 2009 Annual Data Report: Atlas of chronic kidney disease and end-stage renal disease in the United States, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. Bethesda, MD, 2009.
  75. Bauer A., Watanabe M.A., Barthel P. et al. QRS duration and late mortality in unselected postinfarction patients of the revasculation era. Eur Heart J. 2006; 27(4): 427-33.
  76. Block G.A., Klassen P.S., Lazarus J.M. et al. Mineral metabolism, mortality and morbidity in maintenance hemodialysis. J Am Soc Nephrol. 2004; 15(8): 2208-18.
  77. National Institute for Health and Clinical Excellence (UK). Hyperphosphataemia in chronic kidney disease. Management of hyperphosphataemia in patients with stage 4 or 5 chronic kidney disease. NICE clinical guideline 157; March 2013.
  78. Sprague S.M. A comparative review of the efficacy and safety of established phosphate binder: calcium, sevelamer, and lanthanum carbonate. Curr Med Res Opin. 2007; 23(12): 3167-75.
  79. Patel L., Bernard L.M., Elder G.J. Sevelamer versus calcium-based binders for treatment of hyperphosphatemia in CKD: a meta-analysis of randomized controlled trials. Clin J Am Soc Nephrol. 2016; 11(2): 232-44.
  80. Floege J., Covic A.C., Ketteler M. et al. A phase III study of the efficacy and safety of a novel iron-based phosphate binder in dialysis patients. Kidney Int. 2014; 86(3): 638-47.
  81. Komaba H., Taniguchi M., Wada A. et al. Parathyroidectomy and survival among Japanese hemodialysis patients with secondary hyperparathyroidism. Kidney Int. 2015; 88(2): 350-9.
  82. Chertow G.M., Block G.A., Correa-Rotter R. et al. Effect of cinacalcet on cardiovascular disease in patients undergoing dialysis. New Engl J Med. 2012; 387(26): 2482-94.
  83. Wheeler D.C., London G.M., Parfrey P.S. et al. Effects of cinacalcet on atherosclerotic and nonatherosclerotic cardiovascular events in patients receiving hemodialysis: the evaluation of cinacalcet HCL therapy to lower cardiovascular events (EVOLVE). J Am Heart Assoc. 2014; 3(6): e001363.
  84. Лентино Д.Р., Лихи Д.Д. Инфекции у диализных больных. В: Руководство по диализу. Ред. Джон Т. Даугирдас, Питер Дж. Блейк, Тодд С. Инг. Пер. с англ. под ред. А.Ю. Денисова и В.Ю. Шило. Третье издание. М.: Центр диализа. - Тверь: ООО "Издательство Триада". 2003: 547-575.
  85. Чучалин А.Г., Синопальников А.И., Козлов Р.С. и соавт. Российское респираторное общество (РРО). Межрегиональная ассоциация по клинической микробио-логии и антимикробной химиотерапии (МАКМАХ). Клинические рекомендации по диагностике, лечению и профилактике тяжелой внебольничной пневмонии у взрослых. Пульмонология. 2014; (4): 13-48.
  86. Chung D.R., Huh K. Novel pandemic influenza A (H1N1) and community associated methicillin resistant Staphylococcus aureus pneumonia. Expert Rev Anti Infect Ther. 2015; 13(2): 197-207.
  87. Moreillon P., Que Y.A. Infective endocarditis. Lancet. 2004; 363(9403): 139-49.
  88. Fowler V.G., Miro J.M., Hoen B. et al. Staphylococcus aureus endocarditis: a consequence of medical progress. JAMA. 2005; 293(24): 3012-21.
  89. Николаев А.Ю. Инфекционный эндокардит на гемодиализе. В: А.Ю. Николаев, Ю.С. Милованов. Лечение почечной недостаточности. Руководство для врачей. 2-издание. М.: МИА. 2011: 463-4.
  90. Ezekowyz J.A., McAlister F.A., Armstrong P.W. Anemia is common in heart failure and is associated with poor outcomes: insights from a cohort of 12 065 patients with new-onset heart failure. Circulation. 2003; 107(2): 223-5.
  91. Philipp S., Ollmann H., Schimk T. et al. The impact of anemia and kidney function in congestive heart failure and preserved systolic function. Nephrol Dial Transplant. 2005; 20(5): 915-9.
  92. Шило В.Ю., Земченков А.Ю., Гуревич К.Я. и соавт. Диагностика и лечение анемии при хронической болезни почек. В: Нефрология. Клинические рекомендации. Под ред. Е.М. Шилов, А.В. Смирнов, Н.Л. Козловская. М.: "Гэотар-Медиа". 2016: 664-87.
  93. Fishbane S. Erythropoiesis-stimulating agent treatment with full anemia correction: a new perspective. Kidney Int. 2009; 75(4): 358-65.
  94. Nakhoul F., Yigla M., Gilman R.et al. The pathogenesis of pulmonary hypertension in haemodialysis patients via arterio-venous access. Nephrol Dial Transplant. 2005; 20(8): 1686-1692.
  95. Von Bibra H., Castro L., Autenrieth G. et al. The effects of arteriovenous shunts on cardiac function in renal dialysis patients - an echocardiographic evaluation. Clin Nephrol. 1978; 9(5): 205-209.
  96. Yigla M., Nakhoul F., Sabag A. et al. Pulmonary hypertension in patients with end-stage renal disease. Chest. 2003; 123(5): 1577-1582.
  97. Clarkson M.R., Giblin L., Brown A. et al. Reversal of pulmonary hypertension after ligation of a brachiocephalic arteriovenous fistula. Am J Kidney Dis. 2002; 40(3): E8.
  98. Yigla M., Abassi Z., Reisner S.A., Nakhoul F. Pulmonary hypertension in hemodialysis patients: an unrecognized threat. Semin Dial. 2006; 19(5): 353-357.
  99. Crowley S.D., Butterly D.W., Peter R.H., Schwab SJ. Coronary steal from a left inter-nal mammary artery coronary artery bypass graft by a left upper extremity ateriovenous hemodialysis fistula. Am J Kidney Dis. 2002; 40(4): 852-855.

Другие статьи по теме


Навигация по статьям
Разделы журнала
Наиболее читаемые статьи
Журнал "Нефрология и диализ"