Abstract

INSERRA, Felipe; LAVENIA, Gustavo; FORCADA, Pedro  and  BELLO, Carlos Castellaro. Systemic Vasculature In Chronic Kidney Disease. Third Part. Rev. nefrol. dial. traspl. [online]. 2020, vol.40, n.3, pp.251-267. ISSN 2346-8548.

In this literature review we present various therapeutic alternatives for vascular stiffness in patients with chronic kidney disease. Here we discussed the role of non-pharmacological treatments with evidence of the benefit of sodium restriction on vascular stiffness, the positive effects in that sense shown by the Mediterranean diet, and the small benefits of physical activity on vascular stiffness in this group of patients. Is in the pharmacological treatment where the best benefits are evidenced; both, on vascular stiffness and on the associated cardiovascular events.

The effectiveness of renin-angiotensin-aldosterone system inhibitors and antialdosteronic drugs to decrease blood pressure and stiffness has been widely demonstrated. Other drugs, such as endothelin receptor blockers, showed their protective effects on the arterial wall, but with potential adverse effects.

This article also reviews the effects of new anti-diabetic drugs, iSLGT2 and aGLP-1 in particular, and their effect on blood pressure and vascular stiffness, particularly in patients with chronic kidney disease. The utility of drugs with effects on the inflammatory cascade and drugs with a potential effect on vascular calcification, complication occurring frequently during renal function replacement treatment, are also reviewed.

In short, this work focuses in the therapeutic interventions on arterial stiffness, with emphasis on the reduction of cardiovascular events and mortality in patients with chronic kidney disease.

Keywords : chronic kidney disease; arterial stiffness; endothelial dysfunction; arterial hypertension; vascular events; chemotherapy; drugs; pharmacotherapy; pulse wave velocity.