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


Review


doi: 10.3389/fmed.2022.877237.


eCollection 2022.

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Review

Liangying Gan et al.


Front Med (Lausanne).


.

Abstract

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.


Keywords:

ACEI/ARB; angiotensin receptor-neprilysin inhibitor; chronic kidney disease; consensus; hypertension.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

References

    1. Kovesdy CP. Epidemiology of chronic kidney disease: an update 2022. Kidney Int Suppl. (2011) 12:7–11. 10.1016/j.kisu.2021.11.003



      DOI



      PMC



      PubMed

    1. GBD Chronic Kidney Disease Collaboration . Global, regional, and national burden of chronic kidney disease, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. (2020) 395:709–33. 10.1016/S0140-6736(20)30045-3



      DOI



      PMC



      PubMed

    1. Stevens PE, Levin A, Kidney Disease: Improving Global Outcomes Chronic Kidney Disease Guideline Development Work Group M. Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline. Ann Intern Med. (2013) 158:825–30. 10.7326/0003-4819-158-11-201306040-00007



      DOI



      PubMed

    1. Jankowski J, Floege J, Fliser D, Böhm M, Marx N. Cardiovascular disease in chronic kidney disease: Pathophysiological insights and therapeutic options. Circulation. (2021) 143:1157–72. 10.1161/CIRCULATIONAHA.120.050686



      DOI



      PMC



      PubMed

    1. Ryu H, Kim J, Kang E, Hong Y, Chae DW, Choi KH, et al. . Incidence of cardiovascular events and mortality in Korean patients with chronic kidney disease. Sci Rep. (2021) 11:1131. 10.1038/s41598-020-80877-y



      DOI



      PMC



      PubMed



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