Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada.
Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada; Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
Can J Cardiol. 2019 Sep;35(9):1220-1227. doi: 10.1016/j.cjca.2019.06.029. Epub 2019 Jul 11.
Chronic kidney disease (CKD) is a growing public health issue worldwide. It is acknowledged that CKD is associated with increased risk of cardiovascular disease, which is the leading cause of morbidity and mortality in this population. The role of the renin-angiotensin-aldosterone system in the pathophysiology of hypertension, and cardiovascular and kidney diseases is well known and the renin-angiotensin-aldosterone system is a major regulator of blood pressure through its effect on body fluids and electrolyte homeostasis. For 2 decades, renin-angiotensin system inhibitors have been the mainstay of treatment for CKD. Clinical trials have shown that prescription of monotherapy with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers reduces albuminuria and slows the progression of nephropathy in patients with diabetes. In clinical practice guidelines, renin-angiotensin system inhibitors are recommended as the antihypertensive drug of choice in patients with CKD with or without diabetes. Moreover, renin-angiotensin system inhibitors have been shown to offer cardiovascular protection beyond those resulting after blood pressure control. However, the benefits of renin-angiotensin system inhibitor prescriptions for patients with advanced CKD remain controversial. Patients with advanced CKD or who undergo dialysis are under-represented in clinical trials, and studies in this population are urgently needed.
慢性肾脏病（CKD）是全球日益严重的公共卫生问题。人们认识到 CKD 与心血管疾病风险增加有关，而心血管疾病是该人群发病率和死亡率的主要原因。肾素-血管紧张素-醛固酮系统在高血压、心血管疾病和肾脏疾病的病理生理学中的作用是众所周知的，该系统通过对体液和电解质平衡的影响来调节血压。20 年来，肾素-血管紧张素系统抑制剂一直是 CKD 治疗的主要方法。临床试验表明，血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂单药治疗可减少蛋白尿并减缓糖尿病患者的肾病进展。在临床实践指南中，肾素-血管紧张素系统抑制剂被推荐为 CKD 患者（无论是否合并糖尿病）的首选降压药物。此外，肾素-血管紧张素系统抑制剂除了控制血压外，还能提供心血管保护。然而，对于晚期 CKD 患者，肾素-血管紧张素系统抑制剂处方的益处仍存在争议。晚期 CKD 患者或接受透析治疗的患者在临床试验中的代表性不足，迫切需要对此类人群进行研究。
