[Local Medical]Poor kidneys and heart disease lead to a vicious cycle of cardio-renal failure

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Text◆He Jianxing Edited by◆Liang Yingxiu

A heart without kidneys cannot detoxify, and a kidney without a heart cannot supply blood. The two are closely related. When one of them is damaged, the other will also suffer. If the functions of both are damaged at the same time, it is cardiorenal syndrome. Only by identifying the cause as early as possible can we Avoid unnecessary harm.

(Kuala Lumpur News) Among human organs, the relationship between the heart and the kidneys is as close and complex as brothers in need. First of all, the heart’s responsibility to the kidneys is to provide sufficient blood.

Once the heart is weak and insufficient blood supply occurs, the body’s organ mechanism will first concentrate blood on important organs such as the heart and brain. At this time, the blood supply to the kidneys will be “sacrificed” first. Without sufficient blood supply, kidney function will be greatly affected.

Myocarditis or blocked arteries accomplice

The kidneys excrete toxins from the body through urine. Once they are unable to obtain sufficient blood supply, or are affected by chronic factors such as comorbidities (diabetes, hypertension, etc.), or acute factors such as bacterial infections, kidney failure will occur and the urine will not be able to be passed through the body. Get rid of toxins. When these toxins continue to accumulate in the body, heart function will inevitably be further affected, because for the body’s organs to function normally, there must be a proper environment, otherwise the body’s functions, including heart function, will continue to decline, forming a vicious cycle that is interlocked .

Nephrology consultant Dr Yew Shiong Shiong pointed out that kidney failure can also cause patients to develop problems such as edema or abdominal swelling. This is because urine output is reduced, and fluid entering through the mouth will remain in the body, forming edema and Elevated blood pressure and heart failure can also cause edema, especially myocarditis and coronary artery obstruction. Comorbidities such as hypertension and diabetes are not only causes of kidney failure, but also accomplices of myocarditis or arterial obstruction.

When water cannot be discharged from the body, a phenomenon of “making ends meet” will occur, that is, water continues to accumulate in the body, causing “flooding”. At this time, the heart will continue to be stretched like a balloon, causing the myocardial blood transfusion function to be blocked, resulting in heart failure. Renal function deteriorates at the same time, which is a typical factor in the formation of Cardiorenal Syndrome (CRS).

“In short, when the heart and kidneys harm each other and begin to deteriorate, whether it is caused by the heart or the kidneys, it can be classified as CRS.”

It is worth noting that some cancer patients may also have CRS, but this is not directly affected by the cancer, but is caused by complications such as sarcopenia or lack of nutrition, or by the heavy burden on the body caused by the drugs used during treatment. .

“Cardiorenal syndrome can be divided into two major categories. The first is acute factors that cause rapid decline in heart and kidney function in just a few days. The most common factors include infection (bacteria or viruses) and sepsis, etc., and this If caused by factors such as these, it can be diagnosed in time and given appropriate medication, including being sent to the intensive care unit for rescue. The recovery rate of heart and kidney function is very high. If it is the second type, that is, chronic factors such as comorbidities that cause heart and kidney function to deteriorate in a few months to If it declines within a few years and causes life-threatening consequences, it will be more difficult and difficult to recover.”

Nearly half of people with heart failure are affected by kidney disease

That’s why it’s important to detect changes in heart or kidney function early. Taking the nephrology department as an example, when the doctor discovers during the consultation that in addition to renal failure, the patient also has the possibility of heart failure in the blood test report, and suggests that the patient needs to do more tests to prove it, the patient actually has heart failure. It is necessary to respect the doctor’s professional opinion, as this may very well change the outcome. Of course, if the patient resolutely chooses to turn a blind eye, there is nothing the doctor can do.

Is the probability of patients suffering from both heart and kidney damage high? He believes it is common, but there is no need to be too anxious about it. “Perhaps 5 out of 10 patients have heart failure, but they are ignored during follow-up visits to the nephrology department due to different circumstances. For example, the nephrologist focuses more on kidney problems during examinations and does not pay attention to the heart. The symptoms of the injury were not discovered, or the relevant doctors lacked experience in this area. In the field of cardiology, there is a similar phenomenon, that is, nearly half of the heart failure patients who seek treatment are also deeply troubled by kidney disease. , which is enough to prove that the heart and kidneys are closely related.

“Furthermore, even if the nephrologist is aware of the symptoms of heart failure and wants to arrange for more tests to confirm the patient (as mentioned above), or to refer the patient to a cardiologist for a heart scan, the mention of having to pay Many patients will refuse the extra cost, even in government hospitals. Even if the doctor has arranged the test, the patients will not go because they think it will take a long time to wait or have to go to another department for follow-up. “

He said that the same situation also occurs in the cardiology department. When the cardiologist realizes that the patient may have kidney failure during diagnosis and wants to arrange for the patient to undergo a kidney test or urine test, the patient will refuse based on the above reasons, so it is necessary to To identify cardiorenal syndrome, in addition to more diagnosis and observation by doctors, it is also important for patients to be aware of the condition.

“From the cases of cardiorenal syndrome that I have been exposed to in the past,

The reason why patients with chronic kidney disease (CKD) are determined is because

One of the reasons is to consult another specialist (cardiology)

Have a heart scan (echocardiogram) or electrocardiogram (ECG).

But with the advancement of medical technology,

In recent years, many international cardiology societies have encouraged modifications to diagnostic guidelines.

Take a blood test for proB-type natriuretic peptide

(Pro Brain Natriuretic Peptide, proBNP) is included in the early diagnosis of heart failure.

As technology continues to advance,

Now a more precise N-terminal pro-B-type natriuretic peptide has been added.

The latter is also more specific for testing myocardial function.

Once the index of high-risk patients is higher than 125pg/ml during the test, it is considered abnormal.

Next step of testing is required, but the results may vary from different laboratories.

It is not possible to generalize, and the doctor’s opinion must still prevail. “

proBNP is a new breakthrough in diagnosing heart failure in recent years. It is also a very convenient test that can be performed at the same time as a blood test. As far as he knows, most government or private hospitals already provide this kind of screening test. In the nephrology department, it is targeted at CKD patients who already have symptoms of heart failure. Usually, if the patient has no other obvious symptoms, it only needs to be tested once a year to two years.

Follow your doctor’s advice and pay attention to your body’s warning signs

He pointed out that to diagnose whether patients with heart failure also have renal function decline, cardiologists should not only pay attention to the creatinine index in the patient’s blood test report, but also pay more attention to the glomerular filtration rate (eGFR) index. If necessary, an additional urine test can be added (to check whether there is urinary protein), so that you can detect whether the patient has a decline in heart and kidney function at the same time, and then take appropriate medication according to the condition to improve it.

Don’t eat too much protein Ketoacid treatment reduces kidney burden

For cardiorenal failure caused by chronic factors, any method that can slow down the decline is worth adopting. In addition to drugs to control chronic diseases, daily diet cannot be ignored, and this includes ketoacid therapy that can slow down renal failure.

If a patient’s heart and kidney function decline, can it be reversed? You Xiongsong said that if acute factors such as bacterial infection or sepsis, or even arterial vascular obstruction cause a rapid decline in heart function, as long as the root cause can be found in time and targeted treatment is given, the heart failure will be improved, kidney function can also be restored, and the chance of reversal will be natural Just high.

“However, damage caused by chronic factors such as comorbidities may not necessarily be reversible. This is because long-term damage has caused organ dysfunction. What can be done is to slow down or prevent its further deterioration.”

For such chronic factors that cause heart and kidney failure, any method that can slow down the decline is worth adopting. In addition to drugs to control chronic diseases, daily diet cannot be ignored, and this includes ketoacid therapy that can slow down renal failure. .

Make sure the patient is getting nutrition

“Ketoacid therapy is regarded as auxiliary therapy. The so-called auxiliary therapy refers to intervention from the aspect of life. When a person’s kidney function is only 30% left, and the 10% stage of kidney dialysis is very close, it is necessary at this time. Avoid unnecessary burden on the kidneys, especially excessive protein intake.”

As for how to choose a low-protein diet and pair it with keto acids, he would encourage you to consult a doctor or dietitian first, including how to pair it with a normal diet, so as to maximize the effect and last longer.

Treatment goals avoid worsening

Among patients with cardiorenal syndrome, when the patient’s renal failure rate is slowed down, it also means that the heart function can be improved, because as I mentioned at the beginning, the heart and kidneys, two brothers in trouble, influence each other. As long as the kidneys It can urinate and detoxify normally, reducing the chance of edema and uremia, and the heart function can also return to normal.

As for the main goal of the treatment of cardiorenal syndrome, it is to avoid the worsening of heart failure and renal failure, but the treatment methods vary from person to person. For example, if there is heart failure first and then renal failure, the heart failure problem must be solved first, and vice versa, the same is true for renal failure. In other words, the concept is the same, but the path is different.

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