Abstract
The article provides a review of data on cardiovascular patients’ treatment, with 1-3 grades of chronic kidney disease (CKD). It is shown that for cardiovascular patients the function of kidneys must be assessed before beginning of treatment, which is important for on-time diagnostics of CKD. Practitioners must remember that patients with the 3rd grade of CKD require specific nephroprotection. On all stages of the disease optimal nephroprotectors are inhibitors of renin-angiotensine system (RAs) (blockers of angiotensine receptors (ARB) and angiotensine converting enzyme inhibitors (ACei)). The evidence provided for relation of ARBs nephroprotective effect with dosage, and that these drugs must be used in highest tolerated dosages, but not in minimal effective dosage that leads to normalization of BP. It is shown that combination of ACei and ARBs with statins enhances cardiorenal protection as a result of nephroprotective effects synergy of statins and RAs inhibitors.
Highlights
В статье представлен обзор данных, касающихся проблем лечения кардиологических пациентов с 1-3 стадиями хронической болезни почек (ХБП)
It is shown that for cardiovascular patients the function of kidneys must be assessed before beginning of treatment, which is important for on-time diagnostics of chronic kidney disease (CKD)
Practitioners must remember that patients with the 3rd grade of CKD require specific nephroprotection
Summary
Примечание: Wouters OJ, O'Donoghue DJ, Ritchie J, et al Early chronic kidney disease: diagnosis, management and models of care. Связан с повышением риска удвоения уровня креатинина в плазме крови или терминальной стадии почечной недостаточности при протеинурии более 1 г/24 ч. Оптимальным уровнем диастолического АД (ДАД) для пациентов с ХБП является уровень 60-79 мм рт.ст. + оценка скорости прогрессирования (СКФ каждые 3 месяца) + выявление и лечение осложнений + ренопротекция: ИАПФ и/или БРА, избегать нефротоксичных препаратов, коррекция дозы ЛС. Для пациентов с ХБП с СД и без СД с экскрецией альбумина >300 мг/24 часа рекомендуются БРА или иАПФ (1B). Назначение блокаторов РАС пациентам с ХБП требует особой осторожности, если уровень калия >5,0 ммоль/л, уровень креатинина >221 мкмоль/л или рСКФ
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