La vasculatura sistémica en la enfermedad renal crónica. Tercera parte

Contenido principal del artículo

Felipe Inserra
Gustavo Lavenia
Pedro Forcada
Carlos Castellaro Bello

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.

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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 25 de octubre de 2020];40(3):251-67. Disponible en: http://revistarenal.org.ar/index.php/rndt/article/view/539
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