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专家共识

血管紧张素受体-脑啡肽酶抑制剂在慢性肾脏病患者中应用的中国专家共识

  • 左力 ,
  • 甘良英 ,
  • 吕晓希 ,
  • 杨向东 ,
  • 赵占正 ,
  • 汤颖 ,
  • 陈源汉 ,
  • 姚颖 ,
  • 洪富源 ,
  • 许钟镐 ,
  • 陈继红 ,
  • 顾乐怡 ,
  • 毛慧娟 ,
  • 刘颖 ,
  • 孙晶 ,
  • 周竹 ,
  • 杜玄一 ,
  • 姜鸿 ,
  • 李勇 ,
  • 孙宁玲 ,
  • 梁馨苓
展开
  • 100044 北京,1中关村肾病血液净化创新联盟

收稿日期: 2022-09-26

  修回日期: 2022-11-22

  网络出版日期: 2023-04-12

Application of Angiotensin Receptor-Neprilysin Inhibitor in Chronic Kidney Disease Patients: Chinese Expert Consensus

  • ZUO Li ,
  • GAN Liang-Ying ,
  • GAN Liang-Ying Xiao-Xi ,
  • YANG Xiang-Dong ,
  • ZHAO Zhan-Zheng ,
  • TANG Ying ,
  • CHEN Yuan-Han ,
  • YAO Ying ,
  • HONG Fu-Yuan ,
  • XU Zhong-Gao ,
  • CHEN Ji-Hong ,
  • GU Le-Yi ,
  • MAO Hui-Juan ,
  • LIU Ying ,
  • SUN Jing ,
  • ZHOU Zhu ,
  • DU Xuan-Yi ,
  • JIANG Hong ,
  • LI Yong ,
  • SUN Ning-Ling ,
  • LIANG Xin-Ling
Expand
  • Zhongguancun Nephrology & Blood Purification Innovation Alliance, Beijing 100044, China

Received date: 2022-09-26

  Revised date: 2022-11-22

  Online published: 2023-04-12

摘要

慢性肾脏病(chronic kidney disease,CKD)是一个全球性公共卫生问题。心血管疾病是导致CKD患者死亡的首位病因,在CKD早期心血管事件的发病率和患病率已经显著升高,并随着肾功能下降呈指数升高,超过50%的我国透析患者死于心脑血管疾病。如何控制心血管事件发生的危险因素、改善预后是CKD的诊治重点。收缩压干预试验(systolic blood pressure intervention trial,SPRINT)研究也证实CKD患者通过强化降压在降低心脑血管事件上的获益。血压不佳不仅增加心血管事件发生风险,还会促进CKD进展。近年来,不断有研究证实在CKD患者中,首个血管紧张素受体-脑啡肽酶抑制剂(angiotensin receptor–neprilysin inhibitor,ARNI)沙库巴曲缬沙坦较肾素-血管紧张素系统抑制剂可进一步有效降低血压,改善合并心力衰竭患者的预后。在此,为更好地指导ARNI在CKD患者中的应用,减少CKD患者心血管事件的发生,由中关村肾病血液净化创新联盟专家组结合循证证据及临床使用经验,制定本共识。

本文引用格式

左力 , 甘良英 , 吕晓希 , 杨向东 , 赵占正 , 汤颖 , 陈源汉 , 姚颖 , 洪富源 , 许钟镐 , 陈继红 , 顾乐怡 , 毛慧娟 , 刘颖 , 孙晶 , 周竹 , 杜玄一 , 姜鸿 , 李勇 , 孙宁玲 , 梁馨苓 . 血管紧张素受体-脑啡肽酶抑制剂在慢性肾脏病患者中应用的中国专家共识[J]. 中国血液净化, 2023 , 22(04) : 241 -253 . DOI: 10.3969/j.issn.1671-4091.2023.04.001

Abstract

Chronic kidney disease (CKD) is a global public health problem, and cardiovascular disease is the most common cause of death in patients with CKD. The incidence and prevalence of cardiovascular events during the early stages of CKD increases significantly with a decline in renal function. More than 50% of dialysis patients die from cardiovascular disease. Therefore, developing effective methods to control risk factors and improve prognosis of cardiovascular disease is the primary focus during the diagnosis and treatment of CKD. For example, the Systolic blood pressure intervention trial (SPRINT) study demonstrated that CKD drugs are effective in reducing cardiovascular and cerebrovascular events by controlling blood pressure. Uncontrolled blood pressure not only increases the risk of these events but also accelerates the progression of CKD. Recent studies have repeatedly confirmed that the first and so far the only angiotensin receptor–neprilysin inhibitor (ARNI) sacubitril/valsartan can reduce blood pressure more effectively than renin–angiotensin system inhibitors and improve the prognosis of heart failure in patients with CKD. Here, to better guide the application of ARNI in patients with CKD, and reduce the occurrence of cardiovascular events,we formulate a consensus based on clinical evidence and experience.

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