References

emcardio

Неотложная кардиология и кардиоваскулярные риски

Emergency Cardiology and Cardiovascular Risks journal

2616-633X

Белорусский государственный медицинский университет

emcardio-244

Research Article

Обзоры и лекции

Reviews and lectures

Патогенетические основы терапии пациентов с декомпенсированной хронической сердечной недостаточностью

Pathogenetic basis of treatment strategies for patients with decompensated chronic heart failure

Герасимёнок

Д. С.

Gerasimionak

D. S.

Пилипчук

Д. В.

Pilipchuk

D. V.

Митьковская

Н. П.

Mitkovskaya

N. P.

Белорусский государственный медицинский университетBelarusian State Medical University

Учреждение здравоохранения «Городская клиническая больница скорой медицинской помощи»Minsk City Emergency Hospital

2019

12112025

582–594

2025

Герасимёнок Д.С., Пилипчук Д.В., Митьковская Н.П.

Gerasimionak D.S., Pilipchuk D.V., Mitkovskaya N.P.

Данная работа распространяется под лицензией Creative Commons Attribution 4.0.

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

https://emcardio.bsmu.by/jour/article/view/244

В статье рассмотрена проблема хронической сердечной недостаточности и влияние ее наличия на почечную функцию. Обсуждены основные механизмы кардиоренальных взаимоотношений. Представлена информация о современной патогенетической тактике лечения хронической сердечной недостаточности с позиции ренальных эффектов. В статье приводятся данные исследований, изучавших возможности терапии застойной сердечной недостаточности, резистентной к диуретическим лекарственным средствам, с использованием вспомогательного оборудования для дегидратации.

The article deals with the problem of chronic heart failure (CHF) and its effect on renal function. The basic mechanisms of cardiorenal relationships are discussed. Information about modern pathogenetic tactics of CHF treatment concerning the renal effects is presented. The article describes research data related to the treatment of congestive heart failure resistant to diuretic drugs with the use of auxiliary equipment for dehydration.

хроническая сердечная недостаточностьдиуретикихроническая болезнь почекгемодиализультрафильтрация

Belarusian State Medical UniversityDepartment of Cardiology and Internal DiseasesMinsk City Emergency Hospital

References1

Mareev V.Y., Ageev F.T., Arutyunov G.P., Koroteev A.V., Mareev YU.V., Ovchinnikov A.G., Belenkov YU.N., Vasyuk YU.A., Galyavich A.S., Garganeeva A.A., Gilyarevskiy S.R., Glezer M.G., Koziolova N.A. [et al.] Nacional’ny’e rekomendacii OSSN, RKO i RNMOT po diagnostike i lecheniyu HSN (chetverty’y peresmotr). Utverjdeny’ na kongresse OSSN 7 dekabrya 2012 goda, na pravlenii ossn 31 marta 2013 i kongresse rko 25 sentyabrya 2013 goda [National Recommendations Pras Cardiology and Internal Medicine on the Diagnosis and Treatment of Chronic Heart Failure (Fourth Revision). Approved AT THE Congress of Chronic 7 December 2012, the Direction Was Founded on March 31, 2013 and Congress Rko 25 Sep 2013]. J Serdechn Nedostatochnost’, 2013, vol. 14, no. 7 (81), pp. 379–472. (in Russian).

Yancy C.W., Jessup M., Bozkurt B., Butler J., Casey D.E.Jr., Drazner M.H., Fonarow G.C., Geraci S.A., Horwich T., Januzzi J.L., Johnson M.R., Kasper E.K., Levy W.C., Masoudi F.A. [et al.] 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol, 2013, vol. 62, no. 16, pp. e147–239.

Gupta A., Ghimire G., Fadi S., Hage F.G. Guidelines in review: 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Nucl Cardiol, 2013, vol. 21, no. 2, pp. 397–399.

Serov V. A. Kardiorenal’ny’e vzaimootnosheniya u bol’ny’h s hronicheskoy serdechnoy nedostatochnost’yu [Cardiorenal relationships in patients with chronic heart failure]: Dis. dokt. med. nauk: 14.01.04. Ul’yanovsk, 2011, 261 p. (in Russian).

Liao L., Allen L.A., Whellan D.J. Economic burden of heart failure in the elderly. Pharmacoeconomics, 2008, vol. 26, no. 6, pp. 447–462.

Arutyunov A.G., Arutyunov G.P. Povtorny’e gospitalizacii u bol’ny’h s sindromom ostroy dekompensacii HSN. Osobennosti, prognosticheskaya znachimost’, novy’e podhody’ k snijeniyu riska ih vozniknoveniya [Re-hospitalization in patients with the syndrome of acute decompensation of CHF. Features, prognostic significance, new approaches to reducing the risk of their occurrence]. Russ Med J, 2013, no. 12, pp. 612–616. (in Russian).

Adams K.F.Jr., Fonarow G.C., Emerman C.L., LeJemtel T.H., Costanzo M.R., Abraham W.T., Berkowitz R.L., Galvao M., Horton D.P. 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, vol. 149, no. 2, pp. 209–216.

O’Connor C.M., Abraham W.T., Albert N.M., Clare R., Gattis Stough W., Gheorghiade M., Greenberg B.H., Yancy C.W., Young J.B., Fonarow G.C. Predictors of mortality after discharge in patients hospitalized with heart failure: an analysis from the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTI-MIZE-HF). Am Heart J, 2008, vol. 156, no. 4, pp. 662–673.

Efremova E.V., Shutov A.M., Borodulina E.O. Motivaciya k lecheniyu bol’ny’h s hronicheskim kardiorenal’ny’m sindromom [Motivation for treatment of patients with chronic cardiorenal syndrome]. Ter Arhiv, 2015, no. 12, pp.13–17. (in Russian).

Ponikowski P., Voors A.A., Anker S.D., Bueno H., Cleland J.G.F., Coats A.J.S., Falk V., González-Juanatey J.R., Harjola V.P., Jankowska E.A., Jessup M., Linde C., Nihoyannopoulos P., Parissis J.T., Pieske B., Riley J.P., Rosano G.M.C., Ruilope L.M., Ruschitzka F., Frans H. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the. Eur Heart J, 2016, vol. 37, iss. 27, pp. 2129–2200.

Bagshaw S.M., Cruz D.N., Aspromonte N., Daliento L., Ronco F., Sheinfeld G., Anker S.D., Anand I., Bellomo R., Berl.T, Bobek I. Epidemiology of cardio-renal syndromes: workgroup statements from the 7th ADQI consensus conference. Nephrol Dial Transplant, 2010, vol. 25, no. 5, pp. 1406–1416.

Foley R.N., Parfrey P.S., Sarnak M.J. Clinical epidemiology of cardiovascular disease in chronic renal disease. Am J Kidney Dis, 1998, vol. 32, suppl. 3, pp. S112–119.

Muhin N.A., Moiseev V.S., Kobalava J.D., Moiseev S.V., Fomin V.V. Kardiorenal’ny’e vzaimodeystviya: klinicheskoe znachenie i rol’ v patogeneze zabolevaniy serdechno-sosudistoy sistemy’ i pochek [Cardiorenal interactions: clinical significance and role in the pathogenesis of diseases of the cardiovascular system and kidneys]. Ter Arhiv, 2004, vol. 76, no. 6, pp. 39–46. (in Russian).

Dzyak G.V., Kaplan P.A. Kardiorenal’ny’y sindrom: patofiziologiya, verifikaciya, podhody’ k lecheniyu [Cardiorenal syndrome: pathophysiology, verification, treatment approaches]. Pochki, 2012, no. 1, pp. 9-18. (in Russian).

Rudenko T.E., Kuty’rina I.M., SHvecov M.YU., SHilov E.M., Novikova M.S. Terapevticheskie strategii lecheniya kardiorenal’nogo sindroma [Therapeutic strategies for the treatment of cardiorenal syndrome]. Lechasch’iy vrach, 2012, no. 1, pp. 71. (in Russian).

Strokov A.G., Gurevich K.YA., Il’in A.P., Denisov A.YU., Zemchenkov A.YU., Andrusev A.M., SHutov E.V., Kotenko O.N., Zlokazov V.B. Lechenie pacientov s hronicheskoy bolezn’yu pochek 5 stadiya (HBP 5) metodami gemodializa i gemodiafil’tracii [Treatment of patients with chronic kidney disease stage 5 (CKD 5) by hemodialysis and hemodiafiltration]: klin. rekomendacii. Utv. 10 mart 2016, 31 p. (in Russian).

Moiseev B.C., Muhin N.A, Smirnov A.V. eds. Nacional’ny’e rekomendacii: serdechnososudisty’y risk i hronicheskaya bolezn’ pochek: strategii kardionefroprotekcii [National recommendations: cardiovascular risk and chronic kidney disease: strategies of cardioprotection]. Klin Nefrologiya, 2014, no. 2, pp. 4–29. (in Russian).

Ronco C., McCullough P., Anker S.D., Anand I., Aspromonte N., Bagshaw S.M., Bellomo R., Berl T., Bobek I., Cruz D.N., Daliento L., Davenport A., Haapio M., Hillege H., House A.A. [et al.] Cardiorenal syndromes: report from the consensus conference of the Acute Dialysis Quality Initiative. Eur Heart J, 2010, vol. 31, no. 6, pp. 703–711. doi: 10.1093/eurheartj/ehp507.

Maslov L.N., Nary’jnaya N.V., Podoksenov YU.K., Mit’kovskaya N.P., Kolyadko A.N., Toropilov D.M. Kardiorenal’ny’y sindrom pri ostroy ishemicheskoy bolezni serdca [Cardiorenal syndrome in acute coronary heart disease]. Med J, 2009, no. 1, pp. 19–23. (in Russian).

Reznik E.V., Gendlin G.E., Gusch’ina V.M., Storojakov G.I. Hronicheskaya bolezn’ pochek u bol’ny’h s hronicheskoy serdechnoy nedostatochnost’yu (Obzor literatury’) [Chronic kidney disease in chronic heart failure patients (Review)]. Nefrologiya i dializ, 2010, vol. 12, no. 1, pp.12-24. (in Russian).

Vesnina J.V., Arsen’eva Y.A. Kardiorenal’ny’y sindrom: sovremenny’e vzglyady’ na problemu vzaimosvyazi zabolevaniy pochek i serdechno-sosudistoy sistemy’ [Cardiorenal syndrome: modern views on the problem of the relationship of kidney diseases and cardiovascular system]. Klinichesk Med, 2012, no. 7, pp. 8–13. (in Russian).

Skvorcov A.A., Pojarskaya N.I. Rol’ neyrogormonal’ny’h sistem v patogeneze hronicheskoy serdechnoy nedostatochnosti [The role of neurohormonal systems in the pathogenesis of chronic heart failure]. Russ Med J, 1999, no. 2, pp. 26–20. (in Russian).

Vizir V.A., Berezin A.E. Kardiorenal’ny’y sindrom [Cardiorenal syndrome]. Arterial’naya Gipertenziya, 2011, no. 2, pp. 100–109. (in Russian).

Rossiyskaya associaciya e`ndokrinologov. Klinicheskie rekomendacii po diagnostike, skrining u, profilaktike i lecheniyu hronicheskoy bolezni pochek u bol’ny’h saharny’m diabetom [Clinical guidelines for the diagnosis, screening, prevention and treatment of chronic kidney disease in patients with diabetes]. Moscow, 2015, 39 p. (in Russian).

Skvorcov A.A., Mareev V.YU. Beta-blokatory’ pri hronicheskoy serdechnoy nedostatochnosti: kakoy tip beta-adrenergicheskoy blokady’ predpochest’? [Beta-blockers in chronic heart failure: what type of beta-adrenergic blockade do you prefer?]. Consilium Medicum, 2001, vol. 3, no. 2, pp. 79–82. (in Russian).

Kry’janovskiy G.N., Akmaev I.G., Aleksandrin V.V., Aleksandrov P.N., Anohina I.P., Ashmarin I.P., Babaeva A.G., Belopol’skaya M.V., Vladimirov YU.A., Volojin A.I., Kry’janovskiy G.N. eds. Dizregulyacionnaya patologiya [Dysregulation pathology]. Moscow, 2002. 96 p. (in Russian).

Gogin E.E. Senenko A.N., Tyurin E.I. Arterial’ny’e Gipertenzii [Arterial hypertension]. 2th ed. L.: Medicina., 1983. 273 p. (in Russian).

Maslov L.N., Nary’jnaya N.V., Podoksenov YU.K., Gorbunov A.S., Jang I., Pey J.M. Rol’ bradikinina v mehanizme ishemicheskogo prekondicionirovaniya serdca Perspektivy’ primeneniya bradikinina v kardiohirurgicheskoy praktike [The role of bradykinin in the mechanism of ischemic preconditioning of the heart Prospects for the use of bradykinin in cardiac surgery]. Vestnik RAMN, 2015, vol. 70, no. 2, pp. 188–195. (in Russian).

McMurray J.J., Adamopoulos S., Anker S.D., Auricchio A., Böhm M., Dickstein K., Falk V., Filippatos G., Fonseca C., Gomez-Sanchez M.A., Jaarsma T., Køber L., Lip G..Y, Maggioni A.P., Parkhomenko A., Pieske B.M., Popescu B.A., Rønnevik P.K., Rutten F.H., Schwitter J., Seferovic P., Stepinska J., Trindade P.T., Voors A.A., Zannad F., Zeiher A. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J, 2012, vol. 33, no. 14, pp. 1787–1847.

Cheng V., Kazanagra R., Garcia A., Lenert L., Krishnaswamy P., Gardetto N., Clopton P., Maisel A. A rapid bedside test for B-type peptide predicts treatment outcomes in patients admitted for decompensate heart failure: a pilot study. J Am Coll Cardiol, 2001, vol. 37, no. 2, pp. 386–391.

Andreev D.A., Mazerkina I.A., Gitel’ E.N., Dobrovol’skiy A.V., Kukes V.G., Sy’chev D.A., Horeva V.A. Izmeneniya mozgovogo natriyureticheskogo peptida pri lechenii dekompensacii hronicheskoy serdechnoy nedostatochnosti [Changes in brain natriuretic peptide in the treatment of decompensation of chronic heart failure]. Kreativn Kardiologiya, 2007, no. 1-2, pp.136–142. (in Russian).

Maisel A. B-type natriuretic peptide measurements in diagnosing of congestive heart failure in the dyspneic emergency department patient. Rev Cardiovasc Med, 2002, vol. 3, suppl. 4, pp. S10–S17.

Gyamdjyan K.A., Drapkina O.M., Maksimov M.L. Galektin-3: klinicheskaya i prognosticheskaya cennost’ opredeleniya u pacientov s hronicheskoy serdechnoy nedostatochnost’yu [Galectin-3: clinical and prognostic value of determination in patients with chronic heart failure]. J Serdechn Nedostatochnost’, 2014, vol. 82, no. 1, pp. 51–55. (in Russian).

Shchekochikhin D.A., Ammary F., Lindenfeld J.A., Schrier R.. Role of diuretics and ultrafiltration in congestive heart failure. Pharmaceuticals, 2013, vol. 6, no. 7, pp. 6851–6866. doi: 10.3390/ph6070851.

Hillege H.L., Nitsch D., Pfeffer M.A., Swedberg K., McMurray J.J., Yusuf S., Granger C.B., Michelson E.L., Ostergren J., Cornel J.H., de Zeeuw D., Pocock S., van Veldhuisen D.J. Renal function as a predictor of outcome in a broad spectrum of patients with heart failure. Circulation, 2006, vol. 113, no. 5. pp. 671–678.

Homin V.V. Hamhoeva M.S. Rezistentnost’ k diuretikam: prichiny’, mehanizmy’, vozmojnosti preodoleniya [Resistance to diuretics: causes, mechanisms, possibilities of overcoming]. Farmateka, 2010, no. 12, pp. 19-23. (in Russian).

Felker G.M., Mentz R.J. Diuretics and ultrafiltration in patients with acute decompensated heart failure. J Am Coll Cardiol, 2012, vol. 59, no. 24, pp. 2145–2153.

Henderson L.W, Besarab A., Michaels A., Bluemle L.W.Jr. Blood purification by ultrafiltration and fluid replacement (diafiltration). Hemodial Int, 2004, vol. 8, no. 1, pp. 10–18.

Magilligan D.J. Indications for ultrafiltration in the cardiac surgical patient. J Thorac Cardiovasc Surg, 1985, vol. 89, no. 2, pp. 183–189.

Ronco C., Ricci Z., Bellomo R., Bedogni F. Extracorporeal ultrafiltration for the treatment of overhydration and congestive heart failure. Cardiology, 2001, no. 96, pp. 155–168.

Silverstein M.E., Ford C.A., Lysaght M.J., Henderson L.W. Treatment of severe fluid overload by ultrafiltratin. N Еngl Мed, 1974, vol. 291, no. 15, pp. 747–751.

Muhoedova T.V., Unarokov Z.M. Opy’t primeneniya sustained low efficiency dialysis (SLED) – tehnologiy zamestitel’noy pochechnoy terapii v lechenii kardiorenal’nogo sindroma s diuretik-refrakterny’mi otekami [Experience of sustained low efficiency dialysis (SLED)-methods renal replacement therapy in treatment cardiorenal syndrome with diuretic-refractory edemas]. Nefrologiya, 2010, vol. 14, no. 1, pp. 63–67. (in Russian).

Kamath S.A. The role of ultrafiltration in patients with decompensated heart failure [electronic resource]. Int J Nephrol, 2011, ID. 190230. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2989745/pdf/IJN2011-190230.pdf. doi: 10.4061/2011/190230.

Bart B.A., Boyle A., Bank A.J., Anand I., Olivari M.T., Kraemer M., Mackedanz S., Sobotka P.A, Schollmeyer M., Goldsmith S.R. Ultrafiltration versus usual care for hospitalized patients with heart failure: the relief for acutely fluid-overloaded patients with decompensated congestive heart failure (RAPID-CHF) trial. J Am Coll Cardiol, 2005, vol. 46, no. 11, pp. 2043–2046.

Costanzo M.R. Ultrafiltration versus intravenous diuretics for patients hospitalized for acute decompensated heart failure. J Am Coll Cardiol, 2007, vol. 49, no. 6, pp. 675–683.

Bart B.A., Goldsmith S.R., Lee K.L., Givertz M.M., O’Connor C.M., Bull D.A., Redfield M.M., Deswal A., Rouleau J.L., LeWinter M.M., Ofili E.O. Ultrafiltration in decompensated heart failure with cardiorenal syndrome. N Engl J Med, 2012, vol. 367, no. 24, pp. 2296–2304.

Barkoudah E., Kodali S., Okoroh J., Sethi R., Hulten E., Suemoto C., Bittencourt M.S. Meta-Analysis of Ultrafiltration versus Diuretics Treatment Option for Overload Volume Reduction in Patients with Acute Decompensated Heart Failure. Arq Bras Cardiol, 2015, vol. 104, no. 5, pp. 417–425.

Macedo E., Bouchard J., Soroko S.H., Chertow G.M., Himmelfarb J., Ikizler T.A., Paganini E.P., Mehta R.L. Fluid accumulation, recognition and staging of acute kidney injury in critically-ill patients. Crit Сare, 2010, vol. 14, no. 3, pp. R.82. doi: 10.1186/cc9004.

Klimenko A.S. Znachenie biologicheskih markerov i bioimpedansnogo vektornogo analiza v diagnostike i prognozirovanii ishodov ostrogo kardiorenal’nogo sindroma pridekompensacii hronicheskoy serdechnoy nedostatochnosti [The importance of biological markers and bioimpedance vector analysis in the diagnosis and prognosis of outcomes of acute cardiorenal syndrome in decompensation of chronic heart failure] : Dis. kand. med. nauk: 14.01.04. Moscow, 2013. 21 p. (in Russian).

Movilli E., Gaggia P., Zubani R., Camerini C., Vizzardi V., Parrinello G., Savoldi S., Fischer M.S., Londrino F., Cancarini G. Association between high ultrafiltration rates and mortality in uraemic patients on regular haemodialysis. Nephrol Dial Transplant, 2007, vol. 22, no. 12, pp. 3547–3552.

Marenzi G., Agostoni P. Hemofiltration in heart failure. Int J Аrtif Оrgans, 2004, vol. 27, no. 12, pp. 1070–1076.

Marenzi G., Lauri G., Grazi M., Assanelli E., Campodonico J., Agostoni P. Circulatory response to fluid overload removal by extracorporeal ultrafiltration in refractory congestive heart failure. J Аm Сoll Сardiol, 2001, vol. 38, no. 4, pp. 963–968.

Costanzo M.R., Saltzberg M., O’Sullivan J., Sobotka P. Early ultrafiltration in patients with decompensated heart failure and diuretic resistance. J Am Сoll Сard, 2005, vol. 46, no. 11, pp. 2047–2051.

Di Leo M., Pacitti A., Bergerone S., Pozzi R. Ultrafiltration in the treatment of refractory congestive heart failure. Clin. Сardiol, 1988, no. 11, pp. 449-452.

Ronco C., Ricci Z. Renal replacement therapies: physiological review. Intensive Сare Мed, 2008, vol. 38, no. 12, pp. 2139–2146. doi: 10.1007/s00134-008-1258-6.

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