MEDIX, God. 27 Br. 147/148  •  Pregledni članak  •  Nefrologija HR ENG

Blokatori RAAS-a u bolesnika s kroničnom bubrežnom bolešćuRAAS blockers in patients with chronic renal disease

Ivana Vuković Brinar, Karlo Kurtov

Progresivni gubitak bubrežne funkcije, kao temeljno obilježje kronične bubrežne bolesti (KBB), uz visoki rizik za kardiovaskularne (KV) incidente važan je klinički izazov. Primjena inhibitora reninangiotenzin-aldosteronskoga sustava (RAAS) opravdana je praktički u svim stadijima KBB-a, primarno zbog povoljnih kardioprotektivnih i renoprotektivnih učinaka. Sukladno kliničkoj praksi i medicini zasnovanoj na dokazima, naglasak treba staviti na blokatore RAAS-a koji su istraživani u kliničkim istraživanjima KBB-a. Irbesartan i losartan preporučeni su u liječenju dijabetičke nefropatije, ramipril je lijek izbora u KBB-u s visokom proteinurijom. Ramipril, trandolapril, lisinopril i perindopril usporuju progresiju bubrežne bolesti, smanjuju proteinuriju te drastično smanjuju incidenciju KV-incidenata, KV i ukupni pomor. Ipak, uključivanje RAAS-blokade nosi rizike povezane s razvojem hiperkalijemije te rjeđe hipotenzije i akutne ozljede bubrega. Kardioprotektivni i renoprotektivni učinak nadmašuju utjecaj kontrole arterijske hipertenzije, dok se rizici mogu minimalizirati adherencijom bolesnika preporučenim mjerama te podrobnim kliničkim praćenjem.

Ključne riječi:
kronična bubrežna bolest; renin-angiotenzin-aldosteronski sustav

Članak u cijelosti pročitajte u tiskanom izdanju MEDIX, God. 27 Br. 147/148

Progressive loss of renal function, as a fundamental feature of chronic renal disease (CKD), with a high risk of cardiovascular (CV) incidents presents an important clinical challenge. The use of renin-angiotensin-aldosterone system (RAAS) inhibitors is justified practically in all stages of CKD, primarily due to positive cardioprotective and renoprotective effects. This review is emphasizing RCT-approved RAAS inhibitors in CKD treatment. Irbesartan and losartan are recommended in treatment of diabetic nephropathy, ramipril is the drug of choice for CKD with high proteinuria. Ramipril, trandolapril, lisinopril and perindopril applied as RAAS inhibition slow CKD progression, lower proteinuria levels, and drastically reduce the incidence of CV events, cardiovascular and overall mortality. Nevertheless, RAAS blockade brings risks associated with the development of hyperkalemia, hypotension and acute kidney injury (AKI). RAAS inhibition is recommended for its protective effect on the heart, blood vessels and kidneys, it outweighs the impact of arterial hypertension control, while the risks can be minimized by patient adherence to recommended measures and detailed clinical monitoring.

Key words:
chronic kidney disease; renin angiotensin aldosterone system