Palabras clave
Síndrome cardiorenal, falla cardíaca descompensada, diurético, resistencia al diurético, ultrafiltración, diálisis peritoneal
Cómo citar
1.
Manzur Barbur MC, Mejía-Sanjuanelo AM, Anaya-Taboada M, García-Domínguez JC, Molano- Triviño A. Estado del arte del síndrome cardiorrenal, ventajas y limitaciones de las terapias conocidas. Rev. Colomb. Nefrol. [Internet]. 23 de febrero de 2021 [citado 3 de julio de 2024];8(2):e517. Disponible en: https://revistanefrologia.org/index.php/rcn/article/view/517
Resumen
Las interacciones entre las enfermedades cardíacas y renales se han clasificado como síndromes cardiorenales. La clasificación actual incluye cinco subtipos, los cuales son: insuficiencia cardíaca aguda que conduce a insuficiencia renal aguda (tipo 1), insuficiencia cardíaca crónica que conduce a insuficiencia renal (tipo 2), lesión renal aguda que conduce a insuficiencia cardíaca (tipo 3), enfermedad renal crónica que conduce a insuficiencia cardíaca (tipo 4) y afecciones sistémicas que conducen a insuficiencia cardíaca y renal (tipo 5) (Tabla 1) (1,2).
En esta revisión discutimos la definición, clasificación, fisiopatología del síndrome cardiorrenal, enfocándonos en el manejo en fases agudas y su recuperación, exponiendo la evidencia actualmente disponible de los diuréticos y la ultrafiltración con el objetivo de intervenir de manera oportuna a nuestros pacientes conociendo las ventajas y limitaciones de cada una de las estrategias de manejo en aras de reducir el riesgo de eventos clínicos, re- hospitalización y muerte.
Citas
1. Rangaswami J, Vivek Bhalla, John E.A. Blair, Tara I. Chang, Salvatore Costa, Krista L. Lentine, Edgar V. Lerma, Kenechukwu Mezue, Mark Molitch, Wilfried Mullens, Claudio Ronco, W.H. Wilson Tang, McCullough PA. Cardiorenal Syndrome: Classification, Pathophysiology, Diagnosis, and Treatment Strategies. Circulation. 2019;139:840–78.
2. Bielecka-dabrowa A, Godoy B, Schefold JC, Koziolek M, Banach M, Bielecka-dabrowa A. Decompensated Heart Failure and Renal Failure?: What Is the Current Evidence?? Curr Heart Fail Rep. 2018;15(4):224–38.
3. Maria Rosa Costanzo, Claudio Ronco, William T. Abraham, Piergiuseppe Agostoni, Jonathan Barasch, Gregg C. Fonarow, Stephen S. Gottlieb, Brian E. Jaski, Amir Kazory, Allison P. Levin, Howard R. Levin, Giancarlo Marenzi, Wilfried Mullens, Dan Negoianu M. Extracorporeal Ultra fi ltration for Fluid Overload in Heart Failure. J Am Cardiol. 2017;69(19):2428–45.
4. Yogasundaram H, Chappell MC, Braam B, Oudit GY. Cardiorenal Syndrome and Heart Failure d Challenges and Opportunities. Can J Cardiol [Internet]. 2019;35(9):1208–19. Available from: https://doi.org/10.1016/j.cjca.2019.04.002
5. Agrawal A, Naranjo M, Kanjanahattakij N, Rangaswami J, Gupta S. Cardiorenal syndrome in heart failure with preserved ejection fraction — an under-recognized clinical entity. Heart Fail Rev. 2019;24:421–37.
6. Villanueva LS, Sánchez BS, Sanjines DS. Tratamiento congestivo?: diuréticos , resistencia diurética y alternativas Papel de la ultrafiltración. Insufic Card. 2018;13(2):72–86.
7. Chitturi C, Novak JE. Diuretics in the Management of Cardiorenal Syndrome. Adv Chronic Kidney Dis [Internet]. 2018;25(5):425–33. Available from: https://doi.org/10.1053/j.ackd.2018.08.008
8. Mullens W, Damman K, Testani JM, Martens P, Mueller C, Lassus J, et al. Evaluation of kidney function throughout the heart failure trajectory – a position statement from the Heart Failure Association of the European Society of Cardiology. Eur Soc Cardiol. 2020;22(4).
9. Felker GM, Lee KL, Bull DA, Redfield MM, Stevenson LW, Goldsmith SR, et al. Diuretic Strategies in Patients with Acute Decompensated Heart Failure. N Engl J Med. 2011;364(9):797–805.
10. Bowman BN, Nawarskas JJ, Anderson JR. Treating Diuretic Resistance. Cardiol Rev. 2016;24(5):256–60.
11. Bruyne LKM De. Mechanisms and management of diuretic resistance in congestive heart failure. Postgrad Med J. 2003;79:268–72.
12. Salvatore Paterna, Sergio Fasullo, Gaspare Parrinello, Sergio Cannizzaro IB. Short-Term Effects of Hypertonic Saline Solution in Acute Heart Failure and Long-Term Effects of a Moderate Sodium Restriction in Patients With Compensated Heart Failure With New York Heart Association Class III (Class C) (SMAC-HF Study). Am J Med Sci [Internet]. 2011;342(1):27–37. Available from: http://dx.doi.org/10.1097/MAJ.0b013e31820f10ad
13. Iacoviello M, Leone M. The Renal Arterial Resistance Index Predicts Worsening Renal Function in Chronic Heart Failure Patients. Cardiorenal Med. 2017;7:42–9.
14. Grande D, Terlizzese P IM. Role of imaging in the evaluation of renal dysfunction in heart failure patients. World J Nephrol. 2017;6(3):86–167.
15. Ciccone MM, Iacoviello M, Gesualdo L, Puzzovivo A, Antoncecchi V, Doronzo A, et al. The renal arterial resistance index?: a marker of renal function with an independent and incremental role in predicting heart failure progression. Eur J Heart Fail. 2014;16:210–6.
16. A. Doronzo, M. Iacoviello, V. Paradies, V. Antoncecchi, F. Monitillo, G. Citarelli, M. Leone, A. Puzzovivo MMC. Presence of high renal arterial resistance index is independently associated with the increase of loop diuretic diuretic dose in heart failure outpatients. Eur Heart J. 2014;35.
17. Costanzo MR, Guglin ME, Saltzberg MT, Jessup ML, Bart BA, Teerlink JR, et al. Ultrafiltration Versus Intravenous Diuretics for Patients Hospitalized for Acute Decompensated Heart Failure. J Am Coll Cardiol. 2007;49(6):675–83.
18. Felker GM, Ellison DH, Mullens W, Cox ZL, Testani JM. Diuretic Therapy for Patients with Heart Failure. J Am Coll Cardiol. 2020;75(10):1178–95.
19. Bart BA, Goldsmith SR, Lee KL, Givertz MM, O’Connor CM, Bull DA, et al. Ultrafiltration in decompensated heart failure with cardiorenal syndrome. N Engl J Med. 2012;367(24):2296–304.
20. Costanzo MR, Negoianu D, Jaski BE, Bart BA, Heywood JT, Anand IS, et al. Aquapheresis Versus Intravenous Diuretics and Hospitalizations for Heart Failure. JACC Hear Fail. 2016;4(2):95–105.
21. Grossekettler L, Schmack B, Meyer K, Brockmann C, Wanninger R, Kreusser MM, et al. Peritoneal dialysis as therapeutic option in heart failure patients. ESC Hear Fail. 2019;6:271–9.
22. Montejo JD, Bajo MA, Peso G, Selgas R. Papel de la diálisis peritoneal en el tratamiento de la insuficiencia cardíaca refractaria. Rev Nefrol. 2010;30:21–7.
23. Kazory A. Peritoneal dialysis for chronic cardiorenal syndrome: Lessons learned from ultrafiltration trials. World J Cardiol. 2015;7(7):392–7.
24. Viglino G, Neri L, Feola M. Peritoneal ultrafiltration in congestive heart failure — findings reported from its application in clinical practice?: a systematic review. Am J Nephrol. 2015;28:29–38.
2. Bielecka-dabrowa A, Godoy B, Schefold JC, Koziolek M, Banach M, Bielecka-dabrowa A. Decompensated Heart Failure and Renal Failure?: What Is the Current Evidence?? Curr Heart Fail Rep. 2018;15(4):224–38.
3. Maria Rosa Costanzo, Claudio Ronco, William T. Abraham, Piergiuseppe Agostoni, Jonathan Barasch, Gregg C. Fonarow, Stephen S. Gottlieb, Brian E. Jaski, Amir Kazory, Allison P. Levin, Howard R. Levin, Giancarlo Marenzi, Wilfried Mullens, Dan Negoianu M. Extracorporeal Ultra fi ltration for Fluid Overload in Heart Failure. J Am Cardiol. 2017;69(19):2428–45.
4. Yogasundaram H, Chappell MC, Braam B, Oudit GY. Cardiorenal Syndrome and Heart Failure d Challenges and Opportunities. Can J Cardiol [Internet]. 2019;35(9):1208–19. Available from: https://doi.org/10.1016/j.cjca.2019.04.002
5. Agrawal A, Naranjo M, Kanjanahattakij N, Rangaswami J, Gupta S. Cardiorenal syndrome in heart failure with preserved ejection fraction — an under-recognized clinical entity. Heart Fail Rev. 2019;24:421–37.
6. Villanueva LS, Sánchez BS, Sanjines DS. Tratamiento congestivo?: diuréticos , resistencia diurética y alternativas Papel de la ultrafiltración. Insufic Card. 2018;13(2):72–86.
7. Chitturi C, Novak JE. Diuretics in the Management of Cardiorenal Syndrome. Adv Chronic Kidney Dis [Internet]. 2018;25(5):425–33. Available from: https://doi.org/10.1053/j.ackd.2018.08.008
8. Mullens W, Damman K, Testani JM, Martens P, Mueller C, Lassus J, et al. Evaluation of kidney function throughout the heart failure trajectory – a position statement from the Heart Failure Association of the European Society of Cardiology. Eur Soc Cardiol. 2020;22(4).
9. Felker GM, Lee KL, Bull DA, Redfield MM, Stevenson LW, Goldsmith SR, et al. Diuretic Strategies in Patients with Acute Decompensated Heart Failure. N Engl J Med. 2011;364(9):797–805.
10. Bowman BN, Nawarskas JJ, Anderson JR. Treating Diuretic Resistance. Cardiol Rev. 2016;24(5):256–60.
11. Bruyne LKM De. Mechanisms and management of diuretic resistance in congestive heart failure. Postgrad Med J. 2003;79:268–72.
12. Salvatore Paterna, Sergio Fasullo, Gaspare Parrinello, Sergio Cannizzaro IB. Short-Term Effects of Hypertonic Saline Solution in Acute Heart Failure and Long-Term Effects of a Moderate Sodium Restriction in Patients With Compensated Heart Failure With New York Heart Association Class III (Class C) (SMAC-HF Study). Am J Med Sci [Internet]. 2011;342(1):27–37. Available from: http://dx.doi.org/10.1097/MAJ.0b013e31820f10ad
13. Iacoviello M, Leone M. The Renal Arterial Resistance Index Predicts Worsening Renal Function in Chronic Heart Failure Patients. Cardiorenal Med. 2017;7:42–9.
14. Grande D, Terlizzese P IM. Role of imaging in the evaluation of renal dysfunction in heart failure patients. World J Nephrol. 2017;6(3):86–167.
15. Ciccone MM, Iacoviello M, Gesualdo L, Puzzovivo A, Antoncecchi V, Doronzo A, et al. The renal arterial resistance index?: a marker of renal function with an independent and incremental role in predicting heart failure progression. Eur J Heart Fail. 2014;16:210–6.
16. A. Doronzo, M. Iacoviello, V. Paradies, V. Antoncecchi, F. Monitillo, G. Citarelli, M. Leone, A. Puzzovivo MMC. Presence of high renal arterial resistance index is independently associated with the increase of loop diuretic diuretic dose in heart failure outpatients. Eur Heart J. 2014;35.
17. Costanzo MR, Guglin ME, Saltzberg MT, Jessup ML, Bart BA, Teerlink JR, et al. Ultrafiltration Versus Intravenous Diuretics for Patients Hospitalized for Acute Decompensated Heart Failure. J Am Coll Cardiol. 2007;49(6):675–83.
18. Felker GM, Ellison DH, Mullens W, Cox ZL, Testani JM. Diuretic Therapy for Patients with Heart Failure. J Am Coll Cardiol. 2020;75(10):1178–95.
19. Bart BA, Goldsmith SR, Lee KL, Givertz MM, O’Connor CM, Bull DA, et al. Ultrafiltration in decompensated heart failure with cardiorenal syndrome. N Engl J Med. 2012;367(24):2296–304.
20. Costanzo MR, Negoianu D, Jaski BE, Bart BA, Heywood JT, Anand IS, et al. Aquapheresis Versus Intravenous Diuretics and Hospitalizations for Heart Failure. JACC Hear Fail. 2016;4(2):95–105.
21. Grossekettler L, Schmack B, Meyer K, Brockmann C, Wanninger R, Kreusser MM, et al. Peritoneal dialysis as therapeutic option in heart failure patients. ESC Hear Fail. 2019;6:271–9.
22. Montejo JD, Bajo MA, Peso G, Selgas R. Papel de la diálisis peritoneal en el tratamiento de la insuficiencia cardíaca refractaria. Rev Nefrol. 2010;30:21–7.
23. Kazory A. Peritoneal dialysis for chronic cardiorenal syndrome: Lessons learned from ultrafiltration trials. World J Cardiol. 2015;7(7):392–7.
24. Viglino G, Neri L, Feola M. Peritoneal ultrafiltration in congestive heart failure — findings reported from its application in clinical practice?: a systematic review. Am J Nephrol. 2015;28:29–38.
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