How To Use ACEI And ARB in Chronic Kidney Disease With Diabetes? Pay Attention To These 3 Points!

The harm of diabetes combined with CKD lies in its significant increase in cardiovascular risk, end-stage renal disease (ESKD), and mortality risk. ACEI can block the conversion of angiotensin I to angiotensin II (Ang II), thereby reducing the systemic and local production of Ang II in the kidney. ARB can directly block Ang II type 1 receptors. Both play a role in lowering blood pressure and protecting the heart and kidneys by blocking the formation of Ang II.

Click to Cistanche for kidney disease

Among them, ACEI/ARB has multiple protective mechanisms for the kidney, including lowering systemic blood pressure, dilating afferent arterioles, improving glomerular filtration membrane permeability, and antagonizing inflammatory effects.

Starting time: ACEI/ARB is the first choice for patients with hypertension and albuminuria

The 2020 "Guidelines for the Prevention and Treatment of Type 2 Diabetes in China" recommends that ACEI or ARB drugs are recommended for diabetic patients with hypertension and a UACR of 30-300 mg/g. For these patients, ACEI or ARB drugs can delay the progression of albuminuria and reduce cardiovascular events, but there is insufficient evidence to reduce the risk of ESKD.

For patients with diabetes and hypertension and UACR>300mg/g or estimated glomerular filtration rate (eGFR) <60mL/min/1.73m2, ACEI or ARB drugs are strongly recommended. For such patients, ACEI or ARB drugs not only reduce cardiovascular events but also delay the progression of kidney disease, including the occurrence of ESKD.

It is worth noting that the above recommendations suggest that for patients with diabetes and CKD with hypertension (especially when albuminuria occurs), ACEI or ARB can be used as the first choice of medication, without distinction. If patients with diabetes and CKD do not have hypertension, can ACEI/ARB still be started?

The Chinese guidelines do not make a clear recommendation, only pointing out that for diabetic patients without hypertension but UACR≥30mg/g, the use of ACEI or ARB drugs can delay the progression of albuminuria, but there is no evidence that ACEI or ARB can reduce major renal endpoint events (such as ESKD).

However, the 2022 Kidney Disease Improving Global Outcomes (KDIGO) guidelines recommend that patients with diabetes and albuminuria but normal blood pressure may consider using ACEI or ARB. The recommendation is based on the INNOVATION study, which showed that such patients still benefited from RASi treatment. Moreover, RASi can reduce the severity of albuminuria, and the severity of albuminuria in such patients is strongly correlated with the risk of renal failure.

Dosage: Start with a low dose and titrate to the highest tolerable dose

When starting ACEI/ARB, it should be noted that the starting dose is not always used, but the dose should be titrated to the highest tolerable dose approved in the instructions to maximize the benefit for the patient.

Other notes: regular monitoring and timely adjustment

ACEI/ARB not only has a hypotensive effect, but also blocks the effect of Ang Ⅱ, causing more obvious dilation of the glomerular efferent arterioles, causing a decrease in intracapsular pressure, and then causing an increase in serum creatinine levels and a decrease in glomerular filtration rate. Therefore, after starting ACEI/ARB or adjusting its dose, it is necessary to monitor changes in blood pressure, blood potassium, and blood creatinine.

Considering the similar effects of ACEI/ARB on CKD, as well as the risks of hyperkalemia and rapid decrease in glomerular filtration rate, the combined use of ACEI and ARB drugs is not recommended.

How Does Cistanche Treat Kidney Disease?

Cistanche is a traditional Chinese herbal medicine used for centuries to treat various health conditions, including kidney disease. It is derived from the dried stems of Cistanche deserticola, a plant native to the deserts of China and Mongolia. The main active components of cistanche are phenylethanoid glycosides, echinacoside, and acteoside, which have been found to have beneficial effects on kidney health.

Kidney disease, also known as renal disease, refers to a condition in which the kidneys are not functioning properly. This can result in a buildup of waste products and toxins in the body, leading to various symptoms and complications. Cistanche may help treat kidney disease ase through several mechanisms.

Firstly, cistanche has been found to have diuretic properties, meaning it can increase urine production and help eliminate waste products from the body. This can help relieve the burden on the kidneys and prevent the buildup of toxins. By promoting diuresis, cistanche may also help Reduce high blood pressure, a common complication of kidney disease.

Moreover, cistanche has been shown to have antioxidant effects. Oxidative stress, caused by an imbalance between the production of free radicals and the body's antioxidant defenses, plays a key role in the progression of kidney disease. ies help neutralize free radicals and reduce Oxidative stress, thereby protecting the kidneys from damage. The phenylethanoid glycosides found in cistanche have been particularly effective in scavenging free radicals and inhibiting lipid peroxidation.

Additionally, cistanche has been found to have anti-inflammatory effects. Inflammation is another key factor in the development and progression of kidney disease. Cistanche's anti-inflammatory properties help reduce the production of pro-inflammatory cytokines and inhibit the activation of inflammation mandatory pathways, thus alleviating inflammation in the kidneys.

Furthermore, cistanche has been shown to have immunomodulatory effects. In kidney disease, the immune system can be dysregulated, leading to excessive inflammation and tissue damage. Cistanche helps regulate the immune response by modulating the production and activity of immune cells, such as T cells and macrophages. This immune regulation helps reduce inflammation and prevent further damage to the kidneys.

Moreover, cistanche has been found to improve renal function by promoting the regeneration of renal tubes with cells. Renal tubular epithelial cells play a crucial role in the filtration and reabsorption of waste products and electrolytes. In kidney disease, these cells can be damaged, leading to damaged renal function. Cistanche's ability to promote the regeneration of these cells helps restore proper renal function and improve overall kidney health.

In addition to these direct effects on the kidneys, cistanche has been found to have beneficial effects on other organs and systems in the body. This holistic approach to health is particularly important in kidney disease, as the condition often affects multiple organs and systems. che has been shown to have protective effects on the liver, heart, and blood vessels, which are commonly affected by kidney disease. By promoting the health of these organs, cistanche helps improve overall kidney function and prevent further complications.

In conclusion, cistanche is a traditional Chinese herbal medicine used for centuries to treat kidney disease. Its active components have diuretic, antioxidant, anti-inflammatory, immunomodulatory, and regenerative effects, which help improve renal function and protect the kidneys from further damage. , cistanche has beneficial effects on other organs and systems, making it a holistic approach to treating kidney disease.