La vasculatura sistémica en la enfermedad renal crónica. Tercera parte
Palabras clave:
enfermedad renal crónica; rigidez arterial; disfunción endotelial; hipertensión arterial; eventos vasculares; quimioterapia; drogas; tratamiento farmacológico; velocidad de la onda de pulso
Resumen
En esta revisión de la literatura presentamos diversos mecanismos terapéuticos para la rigidez vascular en pacientes con enfermedad renal crónica. En el ámbito de la terapéutica no farmacológica la restricción de sodio y la indicación de dieta mediterránea han demostrado efectos benéficos, mientras que acerca de la indicación de actividad física aún no hay evidencia clara sobre su utilidad para disminuir la rigidez vascular en este grupo específico de pacientes. Es con tratamiento farmacológico donde se evidencian los mayores beneficios, tanto en la rigidez vascular como en los eventos cardiovasculares asociados. Está ampliamente demostrada la efectividad de los inhibidores del sistema renina-angiotensina-aldosterona y de los fármacos antialdosterónicos para disminuir la presión y la rigidez arterial. Otras drogas, como los bloqueadores del receptor de endotelina, han demostrado sus efectos protectores sobre la pared arterial, aunque no están carentes de potenciales efectos adversos.
También repasamos los resultados obtenidos con el uso de las nuevas drogas antidiabéticas, en particular los iSLGT2 y los aGLP-1, y su efecto sobre la presión arterial y la rigidez vascular, en particular en pacientes con enfermedad renal crónica. Se revisan además la utilidad de aquellas drogas con efecto sobre la cascada inflamatoria y sobre las calcificaciones vasculares, muy propensas durante los tratamientos sustitutivos de la función renal.
Este trabajo se enfoca, en síntesis, en las diversas intervenciones terapéuticas sobre la rigidez arterial, con énfasis en la disminución de eventos cardiovasculares y de la mortalidad en pacientes con enfermedad renal crónica.
Citas
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2) Inserra F, Lavenia G, Forcada P, Castellaro Bello C. La vasculatura sistémica en la enfermedad renal crónica. Segunda parte. Rev Nefrol Dial Traspl. 2020;40(1):62-75.
3) Blacher J, Safar ME, Guerin AP, Pannier B, Marchais SJ, London GM. Aortic pulse wave velocity index and mortality in end-stage renal disease. Kidney Int. 2003;63(5):1852-60. doi: 10.1046/j.1523-1755.2003.00932.x.
4) Blacher J, Guerin AP, Pannier B, Marchais SJ, Safar ME, London GM. Impact of aortic stiffness on survival in end-stage renal disease. Circulation. 1999;99(18):2434-9. doi: 10.1161/01.cir.99.18.2434.
5) Salvi P, Giannattasio C, Parati G. High sodium intake and arterial stiffness. J Hypertens. 2018;36(4):754-8. doi: 10.1097/HJH.0000000000001658.
6) Saran R, Padilla RL, Gillespie BW, Michael Heung M, Hummel SL, Derebail VK, et al. A Randomized crossover trial of dietary sodium restriction in stage 3-4 CKD. Clin J Am Soc Nephrol. 2017;12(3):399-407. doi:10.2215/CJN.01120216.
7) D'Elia L, Galletti F, La Fata E, Sabino P, Strazzullo P. Effect of dietary sodium restriction on arterial stiffness: systematic review and meta-analysis of the randomized controlled trials. J Hypertens. 2018;36(4):734-43. doi: 10.1097/HJH.0000000000001604.
8) Siriopol D, Covic A, Iliescu R, Kanbay M, Tautu O, Radulescu L, et al. Arterial stiffness mediates the effect of salt intake on systolic blood pressure. J Clin Hypertens. 2018;20(11):1587-94. doi: 10.1111/jch.13399.
9) Valtuille R. Potential novel benefits of sodium restriction in chronic kidney disease [published online ahead of print, 2020 Jun 15]. Curr Hypertens Rev. 2020;10. doi: 10.2174/1573402116666200615152139.
10) Jennings A, Berendsen AM, de Groot LCPGM, Feskens EJM, Brzozowska A, Sicinska E, et al. Mediterranean-style diet improves systolic blood pressure and arterial stiffness in older adults. Hypertension. 2019;73(3):578-86. doi: 10.1161/HYPERTENSIONAHA.118.12259.
11) Chauveau P, Aparicio M, Bellizzi V, Campbell K, Hong X, Johansson L, et al. Mediterranean diet as the diet of choice for patients with chronic kidney disease. Nephrol Dial Transplant. 2018;33(5):725-35. doi: 10.1093/ndt/gfx085.
12) Van Craenenbroeck AH, Van Craenenbroeck EM, Van Ackeren K, Vrints CJ, Conraads VM, Verpooten GA, et al. Effect of moderate aerobic exercise training on endothelial function and arterial stiffness in CKD stages 3-4: a randomized controlled trial. Am J Kidney Dis. 2015;66(2):285-96. doi: 10.1053/j.ajkd.2015.03.015.
13) Koh KP, Fassett RG, Sharman JE, Coombes JS, Williams AD. Effect of intradialytic versus home-based aerobic exercise training on physical function and vascular parameters in hemodialysis patients: a randomized pilot study. Am J Kidney Dis. 2010;55(1):88-99. doi: 10.1053/j.ajkd.2009.09.025.
14) Mallamaci F, Pisano A, Tripepi G. Physical activity in chronic kidney disease and the EXerCise Introduction To Enhance trial. Nephrol Dial Transplant. 2020;35(Suppl. 2):ii18-ii22. doi: 10.1093/ndt/gfaa012.
15) Guerin AP, Blacher J, Pannier B, Marchais SJ, Safar ME, London GM. Impact of aortic stiffness attenuation on survival of patients in end-stage renal failure. Circulation. 2001;103(7):987-92. doi: 10.1161/01.cir.103.7.987.
16) Pickup L, Radhakrishnan A, Townend JN, Ferro CJ. Arterial stiffness in chronic kidney disease: a modifiable cardiovascular risk factor? Curr Opin Nephrol Hypertens. 2019;28(6):527-36. doi: 10.1097/MNH.0000000000000535.
17) Morgan T, Lauri J, Bertram D, Anderson A. Effect of different antihypertensive drug classes on central aortic pressure. Am J Hypertens. 2004;17(2):118-23. doi: 10.1016/j.amjhyper.2003.09.012.
18) Mallareddy M, Parikh CR, Peixoto AJ. Effect of angiotensin-converting enzyme inhibitors on arterial stiffness in hypertension: systematic review and meta-analysis. J Clin Hypertens (Greenwich). 2006;8(6):398-403. doi: 10.1111/j.1076-7460.2006.05418.x.
19) Shahin Y, Khan JA, Chetter I. Angiotensin converting enzyme inhibitors effect on arterial stiffness and wave reflections: a meta-analysis and meta-regression of randomised controlled trials. Atherosclerosis. 2012;221(1):18-33. doi: 10.1016/j.atherosclerosis.2011.12.005.
20) Georgianos PI, Sarafidis PA, Lasaridis AN. Arterial stiffness: a novel cardiovascular risk factor in kidney disease patients. Curr Vasc Pharmacol. 2015;13(2):229-38. doi: 10.2174/15701611113119990147.
21) Georgianos PI, Pikilidou MI, Liakopoulos V, Balaskas EV, Zebekakis PE. Arterial stiffness in end-stage renal disease-pathogenesis, clinical epidemiology, and therapeutic potentials. Hypertens Res. 2018;41(5):309-19. doi: 10.1038/s41440-018-0025-5.
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Publicado
2020-09-16
Cómo citar
1.
Inserra F, Lavenia G, Forcada P, Castellaro Bello C. La vasculatura sistémica en la enfermedad renal crónica. Tercera parte. Rev Nefrol Dial Traspl. [Internet]. 16 de septiembre de 2020 [citado 26 de diciembre de 2024];40(3):251-67. Disponible en: http://revistarenal.org.ar/index.php/rndt/article/view/539
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Esta obra está bajo licencia internacional Creative Commons Reconocimiento-NoComercial-CompartirIgual 4.0.
