References

nid

Нефрология и диализ

Nephrology and Dialysis

1680-44222618-9801

Российское диализное общество

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

nid-340

Research Article

ОБЗОРЫ И ЛЕКЦИИ

REVIEWS AND LECTURES

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

Сardiorenal syndrome in patients on renal replacement therapy (A review)

Шутов

Е. В.

Shutov

E. V.

shutov_e_v@mail.ru

Николаев

А. Ю.

Nickolaev

A. Yu.

noemail@neicon.ru

Филатова

Н. Н.

Filatova

N. N.

noemail@neicon.ru

ГБУЗ ГКБ им. С.П. Боткина Департамента здравоохранения г. Москвы; ФГБОУ ДПО РМАНПО Минздрава РоссииРоссияBotkin Clinical City Hospital; Russian Medical Academy of Continuous Professional EducationRussian Federation

ФГБОУ ДПО РМАНПО Минздрава РоссииРоссияRussian Medical Academy of Continuous Professional EducationRussian Federation

2018

12082024

203262273

2024

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

Shutov E.V., Nickolaev A.Y., Filatova N.N.

Данная работа распространяется под лицензией Creative Commons Attribution 4.0.

This work is licensed under a Creative Commons Attribution 4.0 License.

https://journal.nephro.ru/jour/article/view/340

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.

In the review authors discusses cardiorenal interactions in patients on renal replacement therapy (RRT), which are considered as a separate type of cardiorenal syndrome (CRS). Frequency and severity of CRS in patients on dialysis correlate with the number of years of the dialysis treatment; they depend on the quality of dialysis and the level of residual renal function. The RRT-associated cardiac pathology include left ventricular hypertrophy, ischemic cardiomyopathy, congestive heart failure, coronary atherosclerosis and calcinosis, severe arrhythmias. The article analyzes the role of such components as malnutrition and dialysis-induced cachexia, membrane biocompatibility, oxidative stress and inflammation, arterio-venous hemodialysis fistula, and a decrease in residual renal function in the development of dialysis-induced CRS. The review examines the mechanisms of progressive myocardial ischemia induced by dialysis: myocardial stunning, hemodialysis-induced hypotension, uremic disease of small blood vessel. Prevention of dialysis-induced CRS includes a choice of the optimal RRT method (peritoneal dialysis or hemodialysis), control of dialysis regime, residual renal function, biocompatibility of membrane, inflammatory markers, body mass index, serum level albumin, phosphate, calcium, parathyroid hormone, fibroblast growth factor-23. Electrocardiogram, ultrasonic monitoring and coronary angiography reveals indications for conservative cardio-protective therapy and angioplasty interventions, including coronary artery bypass surgery and cardiac pacemaker implantation, in patients with dialysis-induced CRS.

гемодиализперитонеальный диализкардиоренальный синдромостаточная функция почекбелково-энергетическая недостаточностьоксидативный стрессартерио-венозная фистулаинтрадиализная гипотензиякоронарный атеросклероззастойная сердечная недостаточностьhemodialysisperitoneal dialysiscardiorenal syndromeresidual renal functionarterio-venous hemodialysis fistulamalnutritionoxidative stresshemodialysis-induced hypotensioncoronary atherosclerosiscongestive heart failure

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The authors declare that there are no conflicts of interest present.