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<meta name="description" content="超高齢社会となり慢性腎臓病（CKD）を合併する心血管疾患患者が増えている．近年の心腎症候群 cardiorenal syndrome（CRS）という概念の導入で，心臓と腎臓の密接な連関は日常診療においても重要な領域となっているが臨床エビデンスは少ない．本書は今まであまり触れられてこなかったCKD合併心血管疾患の疫学，病態，機序，診断，リスク層別化，治療について，執筆陣のエキスパートオピニオンを盛り">

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		<h1 class="catchCopy">腎機能が低下した心血管疾患の治療に悩む現状を打破する一冊！</h1>
		

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					編集：伊藤　浩（岡山大学大学院医歯薬学総合研究科循環器内科学教授）
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		<div class="headers"><h3 class="current content">内容</h3><h3 class="preface">序文</h3><h3 class="indexes">主要目次</h3></div><section class="current content">超高齢社会となり慢性腎臓病（CKD）を合併する心血管疾患患者が増えている．近年の心腎症候群 cardiorenal syndrome（CRS）という概念の導入で，心臓と腎臓の密接な連関は日常診療においても重要な領域となっているが臨床エビデンスは少ない．本書は今まであまり触れられてこなかったCKD合併心血管疾患の疫学，病態，機序，診断，リスク層別化，治療について，執筆陣のエキスパートオピニオンを盛り込み，現時点でのスタンダードを確立することを目指した一冊．</section><section class="preface">序　文<br><br>　超高齢社会となり慢性腎臓病（CKD）を合併する心血管疾患患者が増えている．特に，心不全患者においては心臓と腎臓との間に密接な連関があることが認識され，心腎連関と呼ばれている．さらに，CKDは冠動脈疾患や心房細動発症のリスクであるとともにそのような患者の生命予後を悪化させることが知られている．CKDがあると検査や薬剤投与や薬剤量が制限されることがあり，それもCKD合併心疾患患者の治療を難しくしている側面である．<br>　では，なぜCKDがあると心血管疾患のリスクが増えるのであろうか？ その機序はまだわかっていないことが多い．さらに，CKD合併心血管疾患患者をどのように治療したらよいのであろうか？ 多くの臨床試験は中等度以上のCKD患者を除外しており，臨床エビデンスが乏しい領域でもある．したがって，日常臨床では正常あるいは軽症CKD患者におけるエビデンスを演繹し，それに自身の臨床経験というスパイスを加えながら治療している医師がほとんどではないであろうか．<br>　本書はこのような現状を打破すべく，重要な領域であるが今まであまり触れられてこなかったCKD合併心血管疾患患者の疫学，病態，機序そして診断・リスク層別化と治療に関して現時点でのスタンダードを確立しようというチャレンジングなものである．当然，エビデンスの乏しい領域であるので，執筆者のエキスパートオピニオンを盛り込んでup to dateな内容にしている．<br>　本書を手にした医師，医療スタッフが診療に役に立ったと思っていただくことがあれば執筆者一同の幸せである．<br><br>2021年3月<br>伊藤　浩</section><section class="indexes">序　章<br>　A　心腎連関（cardio-renal connection）は何が問題なのか？<br><br>Ⅰ　心不全と腎不全の関係を考える－cardio-renal syndrome<br>　A　cardiorenal syndrome （CRS）とは？<br>　B　CRS type1－急性心不全とAKI<br>　　1　なぜAKIが起きるか？<br>　　2　AKIの診断<br>　　3　心筋傷害の診断<br>　　4　急性心不全患者の利尿をどうするか？<br>　　5　利尿以外の心不全薬物治療をどうするか？<br>　C　CRS type2―慢性心不全とCKD<br>　　1　CKD合併による慢性心不全患者の予後<br>　　2　慢性心不全患者で腎機能が悪化する機序は？<br>　　3　塩分制限と水分制限<br>　　4　慢性期の利尿薬投与<br>　　5　HFrEF患者の薬物療法<br>　　6　HFpEF患者の薬物療法<br>　　7　SGLT2阻害薬の心腎保護効果<br>　　8　腎機能悪化を防ぐために回避すべき薬剤<br>　　9　デバイス治療の有効性<br>　　10　再入院予防のために注意すべきこと<br>　　11　心臓リハビリと腎臓リハビリ<br>　　12　左室補助循環と腎機能<br>　　13　CKD合併症の治療<br>　　14　末期心不全患者の緩和ケア<br>　　［Meet the expert］Fontan術後のCKD<br>　D　CRS type3　急性腎障害による心不全<br>　E　CRS type4　CKDの結果生じる慢性心不全とは？<br>　F　CRS type5　二次性の心臓と腎臓障害<br><br>Ⅱ　腎不全と心血管イベントの関係を考える<br>　A　疫学と機序<br>　　1　CKDで増加する冠動脈疾患<br>　　2　CKDと動脈硬化－その機序<br>　　3　尿毒素と動脈硬化<br>　B　診　断<br>　　1　CKD合併冠動脈疾患患者の特徴<br>　　2　CKD合併急性心筋梗塞の特徴<br>　　［Topics］CKD患者だけでもトロポニンが上昇する？<br>　　3　冠動脈疾患の診断<br>　　［Topics］CKDと冠動脈石灰化<br>　　［Meet the expert］造影剤腎症をどのように予防するか<br>　C　治　療<br>　　1　薬物治療<br>　　2　血行再建の適応と選択<br>　D　末梢動脈疾患<br>　　1　疫学と診断<br>　　2　治　療<br><br>Ⅲ　腎不全と不整脈を考える<br>　A　心房細動<br>　　1　疫学と機序<br>　　2　病　態<br>　　3　抗凝固療法<br>　　4　カテーテルアブレーション<br>　B　CKDと突然死<br><br>Ⅳ　透析と腎移植の心血管疾患への影響を考える<br>　A　透析患者<br>　　1　透析と心血管疾患－疫学<br>　　2　透析の心血管系への影響<br>　　3　冠動脈疾患の特徴と診断<br>　　4　冠動脈疾患の治療－薬物治療と血行再建<br>　　5　心不全の診断<br>　　6　心不全の治療<br>　B　腎移植患者<br>　　1　動脈硬化への影響<br>　　2　心不全への影響<br><br>索　引</section></article>
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