Patients with chronic kidney disease will experience gradual decline of kidney functions and develop a series of symptoms and metabolic disorders. With the continuous progression of CKD, patients will develop many extra-renal manifestations among which heart failure is one serious cardiovascular complication and also one of the major causes of death for CKD patients.
Why chronic kidney disease will cause heart failure?
1. Uremic toxins. Impaired kidneys can not remove metabolic wastes and toxins out of the blood efficiently, the building up of toxins can cause myocardial lesions, myocardial dysfunction and heart failure.
2. Hypertension. Long term high blood pressure can add overload to the heart and cause hypertrophy of ventricular wall and heart enlargement. Kidney disease can increase catecholamine concentration in the blood which has much to do with heart failure. Besides, high blood pressure can speed up atherosclerosis and promote the occur of heart failure.
3. Too much blood volume. Kidney disease can cause increase cardiac output and make the heart over-work. Too much strain to the heart and myocardial ischemia can cause heart failure.
4. Renal anemia. Kidney failure can cause renal anemia which can worsen myocardial ischemia and decline of myocardial functions.
5. Metabolic acidosis and electrolytes disorder. Disturbance of electrolytes and acidosis can cause cardiac arrhythmia and heart failure.
Treatments for chronic kidney disease with heart failure
Treatment for heart failure for CKD patients is on difficulty and hot topic in clinic, the following are some possible treatments.
ACEI and ARB
ACEI and ARB drugs can to a certain degree slow down or block the progression of heart failure and worsening of kidney functions. However patients may have elevated creatinine level and sharp decline of GFR. These medicines should be avoided if patients have serum creatinine higher than 265.2 or hyperkalaemia.
Rh-EPO can increase red blood cells and increase blood and oxygen supply to kidneys, hearts so as to slow down illness progression. Some scholar think that EPO can be given when patients have hemoglobin lower than 12 and the ideal level is 13.5. However this has not received consensus and its safety and effectiveness needs further tests.
Aspirin can affect kidney functions, but small dosage is safe for CKD patients. The intake of other antithrombotic drugs should consider the patients’ illness conditions.
Receptor blocker typically does not worsen renal functions. Research has found that receptor blocker can prolong the life span for chronic heart failure patients.
When edema is alleviated, receptor blocker can be used to treat heart failure especially those that have ischemic heart disease and rapidity atrial fibrillation.
For those that have severely diminished kidney functions, receptor blockers that need to be discharged through the kidneys should be avoided to reduce extra burdens to the kidneys.
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