心臓機能不全とエジェクションフラクションの低下,慢性腎臓疾患の患者に対する根拠に基づいた医療療法
Iris E Beldhuis1, Carolyn S P Lam1,2, Jeffrey M Testani3
1University of Groningen, Department of Cardiology, University Medical Center Groningen, The Netherlands (I.E.B., C.S.P.L., A.A.V., J.M.t.M., K.D.).
Circulation
|February 28, 2022
まとめ
3B段階までの慢性腎臓病 (CKD) の患者では,通常安全で有効です. 進行したCKDに対する特定のHFrEF薬の証拠はありますが,ステージ5についてはデータが不足しています.
科学分野:
- 腎臓科
- 心臓病科
- 薬理学について
背景:
- 慢性腎臓病 (CKD) は,心不全の併発性であり,エジェクション分数減少 (HFrEF) がある.
- CKDは心不全の予後を悪化させ,HFrEFの治療決定に影響します.
- 過去の治験の除外により,HFrEF治療の進行したCKDに関するデータは限られている.
研究 の 目的:
- 慢性腎臓病の段階が異なる患者におけるHFrEFに対する医療療法の安全性と有効性を検討する.
- CKDの重症性を考慮して,HFrEF治療の管理に関するガイドラインを提供すること.
- HFrEF治療の開始時のeGFR減少に関する懸念に対処するために.
主な方法:
- CKD集団に焦点を当てたHFrEFにおける重要な臨床試験と最近の臨床試験のレビュー.
- 異なるCKD段階 (eGFRレベル) での薬効性および耐受性のデータの分析.
- 進行したCKD (第4段階および第5段階) の特定の薬物クラスに関する証拠の評価.
主要な成果:
- ほとんどのHFrEF薬種は,全因死亡率および心血管疾患死亡/HF入院までCKDステージ3B (eGFR ≥30mL/min/1.73m2) に安全で有効である.
- CKDステージ4では,ナトリウム・グルコースコトランスポーター2阻害剤および他の薬剤は,心血管死/心血管不全の入院の証拠を示しているが,データは限られている.
- 腎臓病第5段階 (eGFR < 15 mL/ min/ 1. 73 m2または透析) のHFrEF治療の安全性または有効性に関するデータは存在しない.
結論:
- HFrEF治療は,CKDステージ3Aおよび3Bでは,大部分安全で有効です.
- CKDのステージ4では,HFrEF治療を慎重に検討し,モニタリングする必要があります.
- 腎臓病第5段階におけるHFrEFの最適な管理を確立するには,さらなる研究が不可欠です.
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