Кардіальні захворювання та хронічна хвороба нирок – фатальний альянс чи нові можливості в лікуванні? (Огляд літератури)
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Анотація
Зростання захворюваності на серцеву недостатність (СН) та хронічну хворобу нирок (ХХН) спостерігається в усьому світі. Комбінація цих патологій значно підвищує ризик смертності та знижує якість життя (ЯЖ) пацієнтів.
Кардіоренальний синдром (КРС) – складний патологічний стан, що характеризується взаємозалежним ураженням серця та нирок, де дисфункція одного органа призводить до порушень функції іншого. Ця коморбідна патологія є значущою проблемою сучасної медицини через високу поширеність та значний вплив на прогноз пацієнтів. Існує п’ять типів КРС. Тип 1: гострий кардіальний синдром, що призводить до гострої ниркової недостатності. Тип 2: хронічна серцева недостатність (ХСН), яка спричиняє прогресуючу ХХН. Тип 3: гостре ураження нирок, що призводить до гострої серцевої недостатності. Тип 4: ХХН, яка спричинює розвиток ХСН. Тип 5: системні захворювання (наприклад сепсис), що одночасно викликають дисфункцію серця та нирок.
Сучасна фармакотерапія КРС спрямована на покращення функції обох органів та загального прогнозу пацієнтів. Зокрема, позитивний влив на перебіг КРС у сучасних дослідженнях продемонстрували: інгібітори натрійзалежного котранспортера глюкози 2-го типу, які знижують рівень глюкози в крові та мають кардіо- і нефропротекторні властивості (дапагліфлозин продемонстрував значне зниження ризику прогресування захворювання нирок, зниження ризику серцево-судинної смерті та госпіталізації при ХСН на 26% навіть у пацієнтів без цукрового діабету); фінеренон (селективний антагоніст мінералокортикоїдних рецепторів), який зменшує запалення та фіброз у нирках і серці, покращуючи результати лікування пацієнтів із КРС; агоністи рецепторів глюкагоноподібного пептиду-1 продемонстрували позитивний вплив на серцево-судинну систему та нирки; сакубітрил-валсартан – комбінований препарат, що інгібує неприлізин та блокує рецептори ангіотензину II, знижуючи ризик госпіталізацій та смерті у пацієнтів із СН.
Впровадження нових препаратів у клінічну практику може значно покращити прогноз та ЯЖ пацієнтів із КРС, проте вкрай актуальними залишається перспектива подальших досліджень та розробка нових терапевтичних стратегій для цієї складної коморбідної патології.
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