醛固酮受体拮抗剂对维持性血液透析患者心血管系统的影响

The effect of aldosterone receptor antagonists on cardiovascular system in maintenance hemodialysis patients

在维持性血液透析患者中,约一半患者死于心血管疾病。醛固酮受体拮抗剂通过作用于肾小管上皮细胞及大脑、血管、心脏等非上皮靶器官起到保护血管、改善心室重构等作用,可显著降低心血管事件死亡率和全因死亡率。但由于醛固酮受体拮抗剂有引起高钾血症的风险,临床尚未广泛使用,通过分析已发表的研究,我们认为在血液透析患者中使用小剂量螺内酯(≤25 mg/d)是安全的。

About half of the patients with maintenance hemodialysis die from cardiovascular diseases.Aldosterone receptor antagonists protect renal vessels and improve ventricular remodeling by acting on renal tubular epithelial cells and non-epithelial target organs such as brain,blood vessels,and heart,so as to significantly reduce cardiovascular event mortality and all-cause mortality.However,due to the risk of hyperkalemia resulting from aldosterone receptor antagonists,they have not been widely used clinically.Based on the analysis of published studies,we believe that low-dose of spironolactone(≤25 mg/d)is safe in hemodialysis patients.