Sica Domenic A
Section of Clinical Pharmacology and Hypertension, Division of Nephrology, Medical College of Virginia, Virginia Commonwealth University, Richmond, VA 23298-0160, USA.
J Clin Hypertens (Greenwich). 2004 Oct;6(10 Suppl 2):24-30. doi: 10.1111/j.1524-6175.2004.03940.x.
The incidence of chronic kidney disease is steadily increasing in the United States. The magnitude of this problem is such that virtually all health care providers are being called upon to manage these patients. The interplay between chronic kidney disease and drug therapy is complex in that the kidney is both a target for drug effect as well as a moderator of drug elimination. Renal drug elimination occurs by filtration, secretion, and/or metabolism. For renally-cleared compounds, drug clearance typically falls in tandem with the loss of renal function. This process is noteworthy for drug accumulation when the glomerular filtration rate approaches the 30-cc/min range. The kidney is a target for drug effect in relationship to blood pressure and protein excretion. Angiotensin-converting enzyme inhibitor and angiotensin receptor blocker therapy (usually given along with a diuretic) are the drug classes that have been shown to be effective for reduction in both blood pressure and protein excretion in the chronic kidney disease patient. A number of questions still remain unanswered in the pharmacotherapy of chronic kidney disease, including the optimal dose for these drugs as well as what represents the most favorable achieved blood pressure.
在美国，慢性肾脏病的发病率正在稳步上升。这个问题的严重程度使得几乎所有医疗保健提供者都被要求管理这些患者。慢性肾脏病与药物治疗之间的相互作用很复杂，因为肾脏既是药物作用的靶点，也是药物消除的调节者。肾脏药物消除通过滤过、分泌和/或代谢进行。对于经肾脏清除的化合物，药物清除率通常会随着肾功能的丧失而同步下降。当肾小球滤过率接近30毫升/分钟范围时，这个过程因药物蓄积而值得关注。肾脏在血压和蛋白质排泄方面是药物作用的靶点。血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂治疗（通常与利尿剂一起使用）已被证明对降低慢性肾脏病患者的血压和蛋白质排泄有效。在慢性肾脏病的药物治疗中，仍有许多问题未得到解答，包括这些药物的最佳剂量以及什么代表最理想的血压控制效果。
