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Application of Angiotensin Receptor-Neprilysin Inhibitor in Chronic Kidney Disease Patients: Chinese Expert Consensus

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机构: [1]Peking Univ Peoples Hosp, Dept Nephrol, Beijing, Peoples R China [2]Chinese Acad Med Sci, Peking Union Med Coll, Inst Mat Med, Beijing, Peoples R China [3]Qilu Hosp Shangdong Univ, Qingdao, Peoples R China [4]Zhengzhou Univ, Affiliated Hosp 1, Zhengzhou, Peoples R China [5]Southern Med Univ, Affiliated Hosp 3, Guangzhou, Peoples R China [6]Guangdong Prov Peoples Hosp, Guangzhou, Peoples R China [7]Huazhong Univ Sci & Technol, Tongji Med Coll, Tongji Hosp, Wuhan, Peoples R China [8]Fujian Prov Hosp, Fuzhou, Peoples R China [9]Jilin Univ, Bethune Hosp 1, Changchun, Peoples R China [10]Shenzhen Baoan Peoples Hosp, Shenzhen, Peoples R China [11]Shanghai Jiao Tong Univ, Renji Hosp, Sch Med, Shanghai, Peoples R China [12]Jiangsu Prov Hosp, Nanjing, Peoples R China [13]Dalian Med Univ, Affiliated Hosp 1, Dalian, Peoples R China [14]Shandong Prov Hosp, Jinan, Peoples R China [15]Kunming Med Univ, Affiliated Hosp 1, Kunming, Peoples R China [16]Harbin Med Univ, Affiliated Hosp 2, Harbin, Peoples R China [17]Peoples Hosp Xinjiang, Urumqi, Peoples R China [18]Fudan Univ, Huashan Hosp, Shanghai, Peoples R China [19]Peking Univ Peoples Hosp, Beijing, Peoples R China
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关键词: chronic kidney disease consensus angiotensin receptor-neprilysin inhibitor hypertension ACEI ARB

摘要:
Chronic kidney disease (CKD) is a global public health problem, and cardiovascular disease is the most common cause of death in patients with CKD. The incidence and prevalence of cardiovascular events during the early stages of CKD increases significantly with a decline in renal function. More than 50% of dialysis patients die from cardiovascular disease, including coronary heart disease, heart failure, arrhythmia, and sudden cardiac death. Therefore, developing effective methods to control risk factors and improve prognosis is the primary focus during the diagnosis and treatment of CKD. For example, the SPRINT study demonstrated that CKD drugs are effective in reducing cardiovascular and cerebrovascular events by controlling blood pressure. Uncontrolled blood pressure not only increases the risk of these events but also accelerates the progression of CKD. A co-crystal complex of sacubitril, which is a neprilysin inhibitor, and valsartan, which is an angiotensin receptor blockade, has the potential to be widely used against CKD. Sacubitril inhibits neprilysin, which further reduces the degradation of natriuretic peptides and enhances the beneficial effects of the natriuretic peptide system. In contrast, valsartan alone can block the angiotensin II-1 (AT1) receptor and therefore inhibit the renin-angiotensin-aldosterone system. These two components can act synergistically to relax blood vessels, prevent and reverse cardiovascular remodeling, and promote natriuresis. Recent studies have repeatedly confirmed that the first and so far the only angiotensin receptor-neprilysin inhibitor (ARNI) sacubitril/valsartan can reduce blood pressure more effectively than renin-angiotensin system inhibitors and improve the prognosis of heart failure in patients with CKD. Here, we propose clinical recommendations based on an expert consensus to guide ARNI-based therapeutics and reduce the occurrence of cardiovascular events in patients with CKD.

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出版当年[2023]版:
大类 | 3 区 医学
小类 | 3 区 医学:内科
最新[2023]版:
大类 | 3 区 医学
小类 | 3 区 医学:内科
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出版当年[2022]版:
Q2 MEDICINE, GENERAL & INTERNAL
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Q1 MEDICINE, GENERAL & INTERNAL

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第一作者机构: [1]Peking Univ Peoples Hosp, Dept Nephrol, Beijing, Peoples R China
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