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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.

Для цитирования: Шутов Е.В., Николаев А.Ю., Филатова Н.Н. Кардиоренальный синдром у больных на заместительной почечной терапии (Обзор литературы). Нефрология и диализ. 2018. 20(3):262-273. doi: 10.28996/2618-9801-2018-3-262-273

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

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