Division of Nephrology, Department of Medicine, London Health Sciences Centre, London, ON, Canada.
Institute of Physiology, University of Zurich, Zurich, Switzerland.
J Intern Med. 2017 Oct;282(4):310-321. doi: 10.1111/joim.12654. Epub 2017 Sep 14.
People with chronic kidney disease (CKD) are at risk of severe outcomes, such as end-stage renal disease or cardiovascular disease, and CKD is a globally increasing health burden with a high personal and economic cost. Despite major progresses in prevention and therapeutics in last decades, research is still needed to reverse this epidemic trend. The regulation of water balance and the state of activation of the vasopressin system have emerged as factors tightly associated with kidney health, in the general population but also in specific conditions; among them, various stages of CKD, diabetes and autosomal dominant polycystic kidney disease (ADPKD). Basic science findings and also epidemiological evidence have justified important efforts towards interventional studies supporting causality, and opening therapeutic avenues. On the basis of recent clinical data, the blockade of V2 vasopressin receptors using tolvaptan in patients with rapidly progressing ADPKD has been granted in several countries, and a long-term randomized trial evaluating the effect of an increase in water intake in patients with CKD is on-going.
患有慢性肾病（CKD）的人有出现严重后果的风险，例如终末期肾病或心血管疾病，并且 CKD 是一个在全球范围内不断增加的健康负担，给个人和经济带来了很高的成本。尽管在过去几十年中在预防和治疗方面取得了重大进展，但仍需要研究来扭转这一流行趋势。水平衡的调节和血管加压素系统的激活状态已成为与肾脏健康密切相关的因素，无论是在普通人群中还是在特定情况下；其中包括 CKD 的各个阶段、糖尿病和常染色体显性多囊肾病（ADPKD）。基础科学发现和流行病学证据为支持因果关系的干预性研究提供了重要依据，并开辟了治疗途径。基于最近的临床数据，在快速进展的 ADPKD 患者中使用托伐普坦阻断 V2 血管加压素受体已在多个国家获得批准，一项评估增加 CKD 患者饮水量对其影响的长期随机试验正在进行中。
