Versiones
- 2023-05-17 (2)
- 2020-12-29 (1)
Palabras clave
Síndrome cardiorenal
Resistencia a los diuréticos
Congestión
Cómo citar
Resumen
La insuficiencia cardiaca (IC) es una pandemia que contribuye en gran parte a la morbi-mortalidad cardiovascular, esta entidad nos enfrenta a grandes retos durante los episodios de descompensación o la IC aguda (ICA). Conocemos que una de sus principales características es la congestión, la misma que con el tiempo ha necesitado ser reinterpretada, sobre todo por su relevancia en el mecanismo fisiopatológico del denominado Síndrome Cardiorrenal (SCR). Estos últimos años nos han permitido o, al menos hemos intentado, comprender la interacción corazón-riñón, la misma que tiene particular atención por una consecuencia inmediata, la resistencia a los diuréticos (RD). Estas características propias de la IC, congestión, descompensaciones, y compromiso de otros órganos, son predictores independientes de eventos adversos en ICA. El enfoque de la interacción de estos dos órganos va más allá de la tasa de filtrado glomerular (TFG) y nuestra obsesión de evaluarla únicamente con la interpretación de la creatinina. La presencia de RD es secundaria a múltiples causas, sin embargo, aún desconocemos si prevenirla es el camino. Ante esta combinación de sucesos, el tratamiento farmacológico en la fase aguda tiene como pilar principal a los diuréticos, fármacos que no han demostrado modificar el curso de la enfermedad, pero que al actuar en el proceso de descongestión, probablemente como punto subrogado, merece otro análisis considerando lo positivo que representa descongestionar a los pacientes. En el manejo de la ICA el tratamiento basado en evidencia lamentablemente es esquivo, y el empirismo razonado predomina, es momento de actuar.
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