在晚期慢性病中优化氨酸- ангиотензин- алдостерон抑制:平衡益处和风险
Sebastian Spencer1,2,3, Sunil Bhandari2,3
1University of Hull.
Current opinion in nephrology and hypertension
|April 10, 2025
概括
在晚期慢性病 (CKD) 中,一般建议继续使用氨酸-血管氨-氨系统抑制剂 (RAASi). STOP-ACEi试验发现停止RAASi没有益处,这表明继续支持脏健康.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 药理学 药理学是指药理学的学科.
背景情况:
- 列宁- ангиотензин- алдостерон系统抑制剂 (RAASi),包括ACE抑制剂 (ACEi) 和ARBs,对于治疗慢性病 (CKD),特别是蛋白尿病至关重要.
- 然而,它们在晚期CKD (eGFR <30 mL/min/1.73 m2) 中的使用是有争议的,原因是高胆血症,急性损伤 (AKI) 和低血压等风险.
研究的目的:
- 审查关于RAASi在晚期CKD中的风险和益处的最新证据.
- 评估STOP-ACEi试验中关于RAASi在该患者群体中的使用的发现.
主要方法:
- 目前文献和元分析的综述.
- 包括来自多中心随机对照试验STOP-ACEi的数据,该试验涉及411名晚期CKD患者.
主要成果:
- 在晚期CKD中停止RAASi并没有减缓EGFR下降或减少3年内的死亡率.
- 继续进行RAASi显示,末期脏病 (ESKD) 的发病率有所下降.
- ACEi可能比ARBs提供稍微更好的脏保护,但两者都降低了心血管风险;组合治疗没有额外的益处,并且增加了不良事件. 辅助疗法可以提高安全性.
结论:
- 对于大多数CKD患者,包括晚期疾病患者,RAASi的延续得到支持,除非禁忌.
- 需要进一步的研究来优化患者选择和辅助策略,以便更安全地使用RAASi.
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