Appropriate interpretation of changes in markers of kidney function is essential during the treatment of acute and chronic heart failure. Historically, kidney function was primarily assessed by serum creatinine and the calculation of estimated glomerular filtration rate. An increase in serum creatinine, also termed worsening renal function, commonly occurs in patients with heart failure, especially during acute heart failure episodes. Even though worsening renal function is associated with worse outcome on a population level, the interpretation of such changes within the appropriate clinical context helps to correctly assess risk and determine further treatment strategies. Additionally, it is becoming increasingly recognized that assessment of kidney function is more than just glomerular filtration rate alone. As such, a better evaluation of sodium and water handling by the renal tubules allows to determine the efficiency of loop diuretics (loop diuretic response and efficiency). Also, though neurohumoral blockers may induce modest deteriorations in glomerular filtration rate, their use is associated with improved long-term outcome. Therefore, a better understanding of the role of cardio-renal interactions in heart failure in symptom development, disease progression and prognosis is essential. Indeed, perhaps even misinterpretation of kidney function is a leading cause of not attaining decongestion in acute heart failure and insufficient dosing of guideline-directed medical therapy in general. This position paper of the Heart Failure Association Working Group on Cardio-Renal Dysfunction aims at improving insights into the interpretation of renal function assessment in the different heart failure states, with the goal of improving heart failure care.

中文翻译：

---

在整个心力衰竭轨迹中评估肾脏功能-欧洲心脏病学会心力衰竭协会的立场声明。

在急性和慢性心力衰竭的治疗过程中，对肾功能标志物变化的正确解释至关重要。从历史上看，肾功能主要通过血清肌酐和估计的肾小球滤过率来计算。血清肌酐升高，也称为肾功能恶化，通常发生在心力衰竭患者中，尤其是在急性心力衰竭发作期间。即使在人群水平上肾功能恶化与预后差有关，在适当的临床背景下对此类变化的解释也有助于正确评估风险并确定进一步的治疗策略。另外，人们越来越认识到，对肾功能的评估不仅仅是仅肾小球滤过率。因此，更好地评估肾小管对钠和水的处理可以确定determine利尿剂的效率（loop利尿剂的反应和效率）。同样，尽管神经体液阻滞剂可能会引起肾小球滤过率的适度下降，但使用它们会改善长期预后。因此，更好地了解心肾相互作用在症状发展，疾病进展和预后中的作用至关重要。的确，甚至对肾功能的误解也许是导致急性心力衰竭未出现充血和一般指导药物治疗剂量不足的主要原因。