Whole-course Management Of Patients With CKD Complicated With Hypertension
Dec 28, 2022
In recent years, chronic kidney disease (CKD) has become increasingly prevalent worldwide. In 2020, a study published in Lancet showed that the number of CKD patients in my country is as high as 132 million. In addition, studies have found that the disease is closely related to cardiovascular disease (CVD), and CKD is associated with an increased risk of death from CVD, and the risk of CKD is doubled in hypertensive patients. Effective management of blood pressure in CKD patients, thereby delaying the progress of CKD, is the direction of joint efforts of relevant organizations and workers in the field of nephrology in my country.
Click on bioflavonoids tablets for kidney disease
To help the construction and development of nephrology and standardize the diagnosis and treatment of CKD combined with cerebrovascular disease (CVD), the "Kidney in the County - Primary Chronic Kidney Disease" is supported by Novartis (China) and hosted by the China County Hospital Directors Alliance/Hainan Boao County Hospital Development Research Center In the project of Merging CVD Diagnosis and Treatment Standards, top nephrology experts and grass-roots doctors from all over the country are invited to discuss new progress and new strategies in CKD diagnosis and treatment. At the "Kidney in County-Zhanjiang Station", he brought a keynote speech on "Looking at the whole-process management "Xin" strategy from the perspective of the kidney event chain", from the perspectives of "the current situation of treatment of CKD combined with hypertension" and "exploration of a new mechanism of drug treatment" Elaborated, hoping to bring more gains to grassroots doctors.
Surveys have shown that CKD patients have a high incidence of hypertension. Almost all patients with advanced CKD have hypertension. Therefore, in the treatment of CKD, attention should be paid to the dual management of blood pressure and proteinuria.
1 Current status of treatment for patients with CKD complicated with hypertension
Hypertension and proteinuria are risk factors that promote the progression of CKD. Therefore, in the treatment of CKD complicated with hypertension, lowering blood pressure and lowering proteinuria should be "two-pronged." As shown in the figure below, blood pressure and proteinuria levels are positively correlated with the risk of end-stage renal disease, and controlling blood pressure and proteinuria is crucial to delaying the progression of CKD.
At present, the traditional antihypertensive treatment plan for CKD patients has mainly based on RASS (renin-angiotensin-aldosterone system) inhibitors. Valsartan is a representative drug of RAAS inhibitory drugs, and many studies have confirmed that it can effectively control blood pressure. In addition, studies have also confirmed that RAAS inhibitors can effectively reduce urinary protein in CKD patients. However, under current treatment methods, the blood pressure and proteinuria compliance rates of CKD patients are still low. The interaction of hypertension and proteinuria will promote the progression of CKD to the end stage.
2 The first angiotensin receptor-neprilysin inhibitor - sacubitril valsartan
RASi (renin-angiotensin-aldosterone system inhibitor) combined with NEPi (neprilysin inhibitor) can synergistically lower blood pressure through multiple mechanisms. While strengthening blood pressure, can reduce proteinuria, slow down the decline of eGFR, and delay the disease progress, bringing more benefits to the entire chain of renal events.
Sacubitril-valsartan (ARNI) is the world's first angiotensin receptor-neprilysin inhibitor, which has multiple effects such as treating heart failure, lowering blood pressure, diuretic natriuresis, and inhibiting myocardial remodeling. Sacubitril and valsartan are not only new cornerstone of heart failure treatment but also have sufficient clinical evidence in reducing blood pressure.
The SBP subgroup study of the PARADIGM-HF study confirmed that sacubitril-valsartan significantly lowered blood pressure in patients with higher SBP; CKD subgroup analysis showed that compared with enalapril, sacubitril-valsartan Significantly delay the decline rate of eGFR up to 23.5%, and at the same time reduce the risk of cardiorenal events and death in patients with heart failure and CKD.
A meta-analysis published in China showed that compared with ACEI/ARB, sacubitril-valsartan can significantly reduce the risk of renal function deterioration.
In addition, a meta-analysis of ASN 2020 showed that compared with ACEI/ARB, sacubitril-valsartan can significantly reduce the risk of hyperkalemia and elevated serum creatinine.
In the KDIGO meeting in 2019, sacubitril-valsartan was included for the first time in the "Consensus of the 2019 Global Kidney Outcomes Organization (KDIGO) Meeting" as a cornerstone drug for the treatment of HFrEF (heart failure with reduced ejection fraction) combined with CKD. In 2020, in the notice for soliciting opinions on the standard practice of blood purification issued by the Chinese Medical Administration and Hospital Administration, it is recommended that patients with hemodialysis and chronic heart failure be treated with ARNI to improve heart failure.
The natriuretic peptide system is a "new target" for antihypertensive therapy. Sacubitril and valsartan are effective in reducing blood pressure and benefit more, providing a new boost for blood pressure management of CKD patients!
for more information:Ali.ma@wecistanche.com
