Abstract：
The wide overlap between the syndromes of chronic kidney disease (CKD) and chronic heart failure (HF) means that familiarity with the 2021 European Society of Cardiology guidelines is of importance to nephrologists. The common risk factors for the two syndromes together with the adverse cardiac structural remodelling associated with CKD means that many kidney disease patients experience breathlessness and fall within the HF phenotypes categorized in the guidelines. The management of HF is evolving rapidly leading to significant changes in the latest guideline iteration. The 2021 guidelines have changed from the 2016 version firstly by an increased focus on identifying the three phenotypes of HF to guide appropriate evidence-based management. Secondly, a new and simplified treatment algorithm for HF with reduced ejection fraction involving the rapid sequential initiation and up-titration of four \'pillars\' of drug treatment-angiotensin-converting enzyme inhibitors or angiotensin-neprilysin inhibitors, beta blockers, mineralocorticoid receptor antagonists and now, thanks to convincing trial data, sodium-glucose co-transporter 2 inhibitors. Thirdly, guidelines for device therapy have been changed with down-graded advice on indications for primary prevention implantable cardioverter defibrillator therapy for patients with non-ischaemic HF and for cardiac resynchronization therapy with left bundle branch block (LBBB) and a QRS duration <150 ms. There are updated treatment plans for HF associated with non-cardiovascular comorbidities including CKD.
摘要：
慢性肾脏疾病和慢性心力衰竭综合征之间的广泛重叠意味着熟悉2021年欧洲心脏病学会指南对肾病学家很重要。这两种综合征的共同危险因素以及与慢性肾脏疾病相关的不良心脏结构重塑意味着许多肾脏疾病患者呼吸困难，属于指南中分类的心力衰竭表型。心力衰竭的管理正在迅速发展，导致最新指南迭代中的重大变化。2021年指南与2016年版本相比有所变化，首先更加注重识别心力衰竭的三种表型，以指导适当的循证管理。其次，一种新的简化的心力衰竭治疗算法，降低了射血分数，包括快速序贯启动和上调4个“支柱”的药物治疗-ACE抑制剂或血管紧张素-脑啡肽抑制剂，β受体阻滞剂,盐皮质激素受体拮抗剂，多亏了令人信服的试验数据，钠-葡萄糖协同转运蛋白-2抑制剂。第三，对于非缺血性心力衰竭患者的一级预防植入式心律转复除颤器治疗和左束支传导阻滞且QRS波持续时间<150ms的心脏再同步治疗的适应症,器械治疗指南已进行了降级建议.对于与非心血管合并症（包括慢性肾脏疾病）相关的心力衰竭，有更新的治疗计划。
