La vasculatura sistémica en la enfermedad renal crónica. Tercera parte

  • Felipe Inserra Grupo de Trabajo Hipertensión Arterial y Daño Vascular, Sociedad Argentina de Nefrología, Buenos Aires, Argentina
  • Gustavo Lavenia Maestría de Mecánica Vascular e Hipertensión Arterial, Universidad Austral, Buenos Aires, Argentina
  • Pedro Forcada Laboratorio Vascular No Invasivo, Centro de Hipertensión, Hospital Universitario Austral, Buenos Aires, Argentina
  • Carlos Castellaro Bello Sección Nefrología, Departamento de Medicina Interna, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno (CEMIC), Buenos Aires, Argentina
Palabras clave: enfermedad renal crónica; rigidez arterial; disfunción endotelial; hipertensión arterial; eventos vasculares; quimioterapia; drogas; tratamiento farmacológico; velocidad de la onda de pulso

Resumen

En esta revisión de la literatura presentamos diversos mecanismos terapéuticos para la rigidez vascular en pacientes con enfermedad renal crónica. En el ámbito de la terapéutica no farmacológica la restricción de sodio y la indicación de dieta mediterránea han demostrado efectos benéficos, mientras que acerca de la indicación de actividad física aún no hay evidencia clara sobre su utilidad para disminuir la rigidez vascular en este grupo específico de pacientes. Es con tratamiento farmacológico donde se evidencian los mayores beneficios, tanto en la rigidez vascular como en los eventos cardiovasculares asociados. Está ampliamente demostrada la efectividad de los inhibidores del sistema renina-angiotensina-aldosterona y de los fármacos antialdosterónicos para disminuir la presión y la rigidez arterial. Otras drogas, como los bloqueadores del receptor de endotelina, han demostrado sus efectos protectores sobre la pared arterial, aunque no están carentes de potenciales efectos adversos.
También repasamos los resultados obtenidos con el uso de las nuevas drogas antidiabéticas, en particular los iSLGT2 y los aGLP-1, y su efecto sobre la presión arterial y la rigidez vascular, en particular en pacientes con enfermedad renal crónica. Se revisan además la utilidad de aquellas drogas con efecto sobre la cascada inflamatoria y sobre las calcificaciones vasculares, muy propensas durante los tratamientos sustitutivos de la función renal.
Este trabajo se enfoca, en síntesis, en las diversas intervenciones terapéuticas sobre la rigidez arterial, con énfasis en la disminución de eventos cardiovasculares y de la mortalidad en pacientes con enfermedad renal crónica.

Citas

1) Inserra F, Castellaro Bello C. La vasculatura sistémica en la enfermedad renal crónica. Primera parte. Rev Nefrol Dial Traspl. 2019;39(4):279-90.

2) Inserra F, Lavenia G, Forcada P, Castellaro Bello C. La vasculatura sistémica en la enfermedad renal crónica. Segunda parte. Rev Nefrol Dial Traspl. 2020;40(1):62-75.

3) Blacher J, Safar ME, Guerin AP, Pannier B, Marchais SJ, London GM. Aortic pulse wave velocity index and mortality in end-stage renal disease. Kidney Int. 2003;63(5):1852-60. doi: 10.1046/j.1523-1755.2003.00932.x.

4) Blacher J, Guerin AP, Pannier B, Marchais SJ, Safar ME, London GM. Impact of aortic stiffness on survival in end-stage renal disease. Circulation. 1999;99(18):2434-9. doi: 10.1161/01.cir.99.18.2434.

5) Salvi P, Giannattasio C, Parati G. High sodium intake and arterial stiffness. J Hypertens. 2018;36(4):754-8. doi: 10.1097/HJH.0000000000001658.

6) Saran R, Padilla RL, Gillespie BW, Michael Heung M, Hummel SL, Derebail VK, et al. A Randomized crossover trial of dietary sodium restriction in stage 3-4 CKD. Clin J Am Soc Nephrol. 2017;12(3):399-407. doi:10.2215/CJN.01120216.

7) D'Elia L, Galletti F, La Fata E, Sabino P, Strazzullo P. Effect of dietary sodium restriction on arterial stiffness: systematic review and meta-analysis of the randomized controlled trials. J Hypertens. 2018;36(4):734-43. doi: 10.1097/HJH.0000000000001604.

8) Siriopol D, Covic A, Iliescu R, Kanbay M, Tautu O, Radulescu L, et al. Arterial stiffness mediates the effect of salt intake on systolic blood pressure. J Clin Hypertens. 2018;20(11):1587-94. doi: 10.1111/jch.13399.

9) Valtuille R. Potential novel benefits of sodium restriction in chronic kidney disease [published online ahead of print, 2020 Jun 15]. Curr Hypertens Rev. 2020;10. doi: 10.2174/1573402116666200615152139.

10) Jennings A, Berendsen AM, de Groot LCPGM, Feskens EJM, Brzozowska A, Sicinska E, et al. Mediterranean-style diet improves systolic blood pressure and arterial stiffness in older adults. Hypertension. 2019;73(3):578-86. doi: 10.1161/HYPERTENSIONAHA.118.12259.

11) Chauveau P, Aparicio M, Bellizzi V, Campbell K, Hong X, Johansson L, et al. Mediterranean diet as the diet of choice for patients with chronic kidney disease. Nephrol Dial Transplant. 2018;33(5):725-35. doi: 10.1093/ndt/gfx085.

12) Van Craenenbroeck AH, Van Craenenbroeck EM, Van Ackeren K, Vrints CJ, Conraads VM, Verpooten GA, et al. Effect of moderate aerobic exercise training on endothelial function and arterial stiffness in CKD stages 3-4: a randomized controlled trial. Am J Kidney Dis. 2015;66(2):285-96. doi: 10.1053/j.ajkd.2015.03.015.

13) Koh KP, Fassett RG, Sharman JE, Coombes JS, Williams AD. Effect of intradialytic versus home-based aerobic exercise training on physical function and vascular parameters in hemodialysis patients: a randomized pilot study. Am J Kidney Dis. 2010;55(1):88-99. doi: 10.1053/j.ajkd.2009.09.025.

14) Mallamaci F, Pisano A, Tripepi G. Physical activity in chronic kidney disease and the EXerCise Introduction To Enhance trial. Nephrol Dial Transplant. 2020;35(Suppl. 2):ii18-ii22. doi: 10.1093/ndt/gfaa012.

15) Guerin AP, Blacher J, Pannier B, Marchais SJ, Safar ME, London GM. Impact of aortic stiffness attenuation on survival of patients in end-stage renal failure. Circulation. 2001;103(7):987-92. doi: 10.1161/01.cir.103.7.987.

16) Pickup L, Radhakrishnan A, Townend JN, Ferro CJ. Arterial stiffness in chronic kidney disease: a modifiable cardiovascular risk factor? Curr Opin Nephrol Hypertens. 2019;28(6):527-36. doi: 10.1097/MNH.0000000000000535.

17) Morgan T, Lauri J, Bertram D, Anderson A. Effect of different antihypertensive drug classes on central aortic pressure. Am J Hypertens. 2004;17(2):118-23. doi: 10.1016/j.amjhyper.2003.09.012.

18) Mallareddy M, Parikh CR, Peixoto AJ. Effect of angiotensin-converting enzyme inhibitors on arterial stiffness in hypertension: systematic review and meta-analysis. J Clin Hypertens (Greenwich). 2006;8(6):398-403. doi: 10.1111/j.1076-7460.2006.05418.x.

19) Shahin Y, Khan JA, Chetter I. Angiotensin converting enzyme inhibitors effect on arterial stiffness and wave reflections: a meta-analysis and meta-regression of randomised controlled trials. Atherosclerosis. 2012;221(1):18-33. doi: 10.1016/j.atherosclerosis.2011.12.005.

20) Georgianos PI, Sarafidis PA, Lasaridis AN. Arterial stiffness: a novel cardiovascular risk factor in kidney disease patients. Curr Vasc Pharmacol. 2015;13(2):229-38. doi: 10.2174/15701611113119990147.

21) Georgianos PI, Pikilidou MI, Liakopoulos V, Balaskas EV, Zebekakis PE. Arterial stiffness in end-stage renal disease-pathogenesis, clinical epidemiology, and therapeutic potentials. Hypertens Res. 2018;41(5):309-19. doi: 10.1038/s41440-018-0025-5.

22) Edwards NC, Steeds RP, Stewart PM, Ferro CJ, Townend JN. Effect of spironolactone on left ventricular mass and aortic stiffness in early-stage chronic kidney disease: a randomized controlled trial. J Am Coll Cardiol. 2009;54(6):505-12. doi: 10.1016/j.jacc.2009.03.066.

23) Chirinos JA, Sardana M, Syed AA, Koppula MR, Varakantam S, Vasim I, et al. Aldosterone, inactive matrix gla-protein, and large artery stiffness in hypertension. J Am Soc Hypertens. 2018;12(9):681-9. doi: 10.1016/j.jash.2018.06.018.

24) Bramlage P, Swift SL, Thoenes M, Minguet J, Ferrero C, Schmieder RE. Non-steroidal mineralocorticoid receptor antagonism for the treatment of cardiovascular and renal disease [published correction appears in Eur J Heart Fail. 2017 Jun;19(6):811]. Eur J Heart Fail. 2016;18(1):28-37. doi: 10.1002/ejhf.444.

25) Gil-Ortega M, Vega-Martín E, Martín-Ramos M, González-Blázquez R, Pulido-Olmo H, Ruiz-Hurtado G, et al. Finerenone reduces intrinsic arterial stiffness in Munich Wistar frömter rats, a genetic model of chronic kidney disease. Am J Nephrol. 2020;51(4):294-303. doi: 10.1159/000506275.

26) Pitt B, Filippatos G, Gheorghiade M, Kober L, Krum H, Ponikowski P, et al. Rationale and design of ARTS: a randomized, double-blind study of BAY 94-8862 in patients with chronic heart failure and mild or moderate chronic kidney disease. Eur J Heart Fail. 2012;14(6):668-75. doi: 10.1093/eurjhf/hfs061.

27) Bakris GL, Agarwal R, Chan JC, Cooper ME, Gansevoort RT, Haller H, et al. Effect of finerenone on albuminuria in patients with diabetic nephropathy: a randomized clinical trial. JAMA. 2015;314(9):884-94. doi: 10.1001/jama.2015.10081.

28) Agabiti-Rosei E, Mancia G, O’Rourke MF, Roman MJ, Safar ME, Smulyan H, et al. Central blood pressure measurements and antihypertensive therapy. A consensus document. Hypertension. 2007;50(1):154-60. doi: 10.1161/HYPERTENSIONAHA.107.090068.

29) Koumaras C, Tziomalos K, Stavrinou E, Katsiki N, Athyros VG, Mikhailidis DP, et al. Effects of renin-angiotensin-aldosterone system inhibitors and beta-blockers on markers of arterial stiffness. J Am Soc Hypertens. 2014;8(2):74-82. doi: 10.1016/j.jash.2013.09.001.

30) Dahlöf B, Sever PS, Poulter NR, Wedel H, Beevers D, Caulfield M, et al. Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentre randomised controlled trial. Lancet. 2005;366(9489):895-906. doi: 10.1016/S0140-6736(05)67185-1.

31) Bakris GL, Sarafidis PA, Weir MR, Dahlöf B, Pitt B, Jamerson K, et al. Renal outcomes with different fixed-dose combination therapies in patients with hypertension at high risk for cardiovascular events (ACCOMPLISH): a prespecified secondary analysis of a randomised controlled trial. Lancet. 2010;375(9721):1173-81. doi: 10.1016/S0140-6736(09)62100-0.

32) Larivière R, Gauthier-Bastien A, Ung RV, St-Hilaire J, Mac-Way F, Richard DE, et al. Endothelin type A receptor blockade reduces vascular calcification and inflammation in rats with chronic kidney disease. J Hypertens. 2017;35(2):376-84. doi: 10.1097/HJH.0000000000001161.

33) Heerspink HJL, Parving HH, Andress DL, Bakris G, Correa-Rotter R, Hou F-F, et al. Atrasentan and renal events in patients with type 2 diabetes and chronic kidney disease (SONAR): a double-blind, randomised, placebo-controlled trial [published correction appears in Lancet. 2019;393(10184):1936]. Lancet. 2019;393(10184):1937-47. doi: 10.1016/S0140-6736(19)30772-X.

34) Patoulias D, Papadopoulos C, Stavropoulos K, Zografou I, Doumas M, Karagiannis A. Prognostic value of arterial stiffness measurements in cardiovascular disease, diabetes, and its complications: The potential role of sodium-glucose co-transporter-2 inhibitors. J Clin Hypertens (Greenwich). 2020;22(4):562-71. doi: 10.1111/jch.13831.

35) Bosch A, Ott C, Jung S, Striepe K, Karg MV, Kannenkeril D, et al. How does empagliflozin improve arterial stiffness in patients with type 2 diabetes mellitus? Sub analysis of a clinical trial. Cardiovasc Diabetol. 2019;18(1):44. doi: 10.1186/s12933-019-0839-8.

36) Batzias K, Antonopoulos AS, Oikonomou E, Siasos G, Bletsa E, Stampouloglou PK, et al. Effects of newer antidiabetic drugs on endothelial function and arterial stiffness: a systematic review and meta-Analysis. J Diabetes Res. 2018;2018:1232583. doi: 10.1155/2018/1232583.

37) Ng P, Stringer SJ, Jesky MD, Yadav P, Athwal R, Dutton M, et al. Allopurinol is an independent determinant of improved arterial stiffness in chronic kidney disease: a cross-sectional study. PLoS One. 2014;9(3):e91961. doi: 10.1371/journal.pone.0091961.

38) Tausche AK, Christoph M, Forkmann M, Richter U, Kopprasch S, Bielitz C, et al. As compared to allopurinol, urate-lowering therapy with febuxostat has superior effects on oxidative stress and pulse wave velocity in patients with severe chronic tophaceous gout. Rheumatol Int. 2014;34(1):101-9. doi: 10.1007/s00296-013-2857-2.

39) Robert D. Bordoxolone - the Phoenix. J Am Soc Nephrol. 2018;29(2):360-1. doi: 10.1681/ASN.2017121317.

40) Nowak KL, Chonchol M, Ikizler TA, Farmer-Bailey H, Salas N, Chaudhry R, et al. IL-1 inhibition and vascular function in CKD. J Am Soc Nephrol. 2017;28(3):971-80. doi:10.1681/ASN.2016040453.

41) Coccheri S, Mannello F. Development and use of sulodexide in vascular diseases: implications for treatment. Drug Des Devel Ther. 2013;8:49-65. doi: 10.2147/DDDT.S6762.

42) Semba RD, Najjar SS, Sun K, Lakatta EG, Ferrucci L. Serum carboxymethyl-lysine, an advanced glycation end product, is associated with increased aortic pulse wave velocity in adults. Am J Hypertens. 2009;22(1):74-9. doi: 10.1038/ajh.2008.320.

43) Stinghen AE, Massy ZA, Vlassara H, Striker GE, Boullier A. Uremic toxicity of advanced glycation end products in CKD. J Am Soc Nephrol. 2016;27(2):354-70. doi: 10.1681/ASN.2014101047.

44) Wei Q, Ren X, Jiang Y, Jin H, Liu N, Li J. Advanced glycation end products accelerate rat vascular calcification through RAGE/oxidative stress. BMC Cardiovasc Disord. 2013;13:13. doi: 10.1186/1471-2261-13-13.

45) Oudegeest-Sander MH, Olde Rikkert MG, Smits P, Thijssen DHJ, van Dijk APJ, Levine BD, et al. The effect of an advanced glycation end-product crosslink breaker and exercise training on vascular function in older individuals: a randomized factorial design trial. Exp Gerontol. 2013;48(12):1509-17. doi: 10.1016/j.exger.2013.10.009.

46) Fassett RG, Robertson IK, Ball MJ, Geraghty DP, Sharman JE, Coombes JS. Effects of atorvastatin on arterial stiffness in chronic kidney disease: a randomised controlled trial. J Atheroscler Thromb. 2010;17(3):235-41. doi: 10.5551/jat.2683.

47) Tonelli M, Wanner C; Kidney Disease: Improving Global Outcomes Lipid Guideline Development Work Group Members. Lipid management in chronic kidney disease: synopsis of the Kidney Disease: Improving Global Outcomes 2013 clinical practice guideline. Ann Intern Med. 2014;160(3):182. doi: 10.7326/M13-2453.

48) Hewitt NA, O'Connor AA, O'Shaughnessy DV, Elder GJ. Effects of cholecalciferol on functional, biochemical, vascular, and quality of life outcomes in hemodialysis patients. Clin J Am Soc Nephrol. 2013;8(7):1143-9. doi: 10.2215/CJN.02840312.

49) Marckmann P, Agerskov H, Thineshkumar S, Bladbjerg E-M, Sidelmann JJ, Jespersen J, et al. Randomized controlled trial of cholecalciferol supplementation in chronic kidney disease patients with hypovitaminosis D. Nephrol Dial Transplant. 2012;27(9):3523-31. doi: 10.1093/ndt/gfs138.

50) Hansen D. A randomised clinical study of alfacalcidol and paricalcitol. Dan Med J. 2012;59(2):B4400.

51) Giakoumis M, Tsioufis C, Dimitriadis K, Sonikian M, Kasiakogias A, Andrikou E, et al. Effects of oral paricalcitol therapy on arterial stiffness and osteopontin in hypertensive patients with chronic kidney disease and secondary hyperparathyroidism. Hellenic J Cardiol. 2019;60(2):108-13. doi: 10.1016/j.hjc.2017.12.010.

52) Rodríguez RA, Spence M, Hae R, Agharazii M, Burns KD. Pharmacologic therapies for aortic stiffness in end-stage renal disease: a systematic review and meta-analysis. Can J Kidney Health Dis. 2020;7:2054358120906974. doi: 10.1177/2054358120906974.

53) Chow KM, Szeto CC, Kwan BC, Cheng PM, Pang WF, Leung CB, et al. Effect of cinacalcet treatment on vascular arterial stiffness among peritoneal dialysis patients with secondary hyperparathyroidism. Nephrology (Carlton). 2014;19(6):339-44. doi: 10.1111/nep.12223.

54) Yu L, Tomlinson JE, Alexander ST, Hensley K, Han C, Dwyer D, et al. Etelcalcetide, A Novel Calcimimetic, Prevents Vascular Calcification in A Rat Model of Renal Insufficiency with Secondary Hyperparathyroidism. Calcif Tissue Int. 2017;101(6):641-53. doi:10.1007/s00223-017-0319-7.

55) Chertow GM, Burke SK, Raggi P; Treat to Goal Working Group. Sevelamer attenuates the progression of coronary and aortic calcification in hemodialysis patients. Kidney Int. 2002;62(1):245-52. doi: 10.1046/j.1523-1755.2002.00434.x.

56) Othmane Tel H, Bakonyi G, Egresits J, Fekete BC, Fodor E, Jarai Z, et al. Effect of sevelamer on aortic pulse wave velocity in patients on hemodialysis: a prospective observational study. Hemodial Int. 2007;11(Suppl 3):S13-21. doi: 10.1111/j.1542-4758.2007.00224.x.

57) Qu X, Jin F, Hao Y, Li H, Tang T, Wang H, et al. Magnesium and the risk of cardiovascular events: a meta-analysis of prospective cohort studies. PLoS One. 2013;8(3):e57720. doi: 10.1371/journal.pone.0057720.

58) Del Gobbo LC, Imamura F, Wu JH, de Oliveira Otto MC, Chiuve SE, Mozaffarian D. Circulating and dietary magnesium and risk of cardiovascular disease: a systematic review and meta-analysis of prospective studies. Am J Clin Nutr. 2013;98(1):160-73. doi: 10.3945/ajcn.112.053132.

59) Tzanakis IP, Stamataki EE, Papadaki AN, Giannakis N, Damianakis NE, Oreopoulos DG. Magnesium retards the progress of the arterial calcifications in hemodialysis patients: a pilot study. Int Urol Nephrol. 2014;46(11):2199-205. doi: 10.1007/s11255-014-0751-9.

60) Schlieper G, Westenfeld R, Krüger T, Cranenburg EC, Magdeleyns EJ, Brandenburg VM, et al. Circulating nonphosphorylated carboxylated matrix gla protein predicts survival in ESRD. J Am Soc Nephrol. 2011;22(2):387-95. doi: 10.1681/ASN.2010040339.

61) Pilkey RM, Morton AR, Boffa MB, Noordhof C, Day AG, Su Y, et al. Subclinical vitamin K deficiency in hemodialysis patients. Am J Kidney Dis. 2007;49(3):432-9. doi: 10.1053/j.ajkd.2006.11.041.

62) Neradova A, Schumacher SP, Hubeek I, Lux P, Schurgers LJ, Vervloet MG. Phosphate binders affect vitamin K concentration by undesired binding, an in vitro study. BMC Nephrol. 2017;18(1):149. doi: 10.1186/s12882-017-0560-3.

63) Aoun M, Makki M, Azar H, Matta H, Chelala DN. High Dephosphorylated-Uncarboxylated MGP in Hemodialysis patients: risk factors and response to vitamin K2, A pre-post intervention clinical trial. BMC Nephrol. 2017;18(1):191. doi: 10.1186/s12882-017-0609-3.

64) Himmelfarb J, Stenvinkel P, Ikizler TA, Hakim RM. The elephant in uremia: oxidant stress as a unifying concept of cardiovascular disease in uremia. Kidney Int. 2002;62(5):1524-38. doi: 10.1046/j.1523-1755.2002.00600.x.

65) Mourad A, Carney S, Gillies A, Jones B, Nanra R, Trevillian P. Acute effect of haemodialysis on arterial stiffness: membrane bioincompatibility? Nephrol Dial Transplant. 2004;19(11):2797-802. doi: 10.1093/ndt/gfh443.

66) Chang JH, Yoon SJ, Han SH, Shin SK, Jeon DW, Yang JY, et al. The impact of dialysis modality on arterial stiffness in patients with end-stage renal disease. Ren Fail. 2010;32(8):947-53. doi: 10.3109/0886022X.2010.502607.

67) Ghigolea AB, Gherman-Caprioara M, Moldovan AR. Arterial stiffness: hemodialysis versus hemodiafiltration. Clujul Med. 2017;90(2):166-70. doi: 10.15386/cjmed-699.

68) Rodríguez RA, Hae R, Spence M, Shea B, Agharazii M, Burns KD. A systematic review and meta-analysis of nonpharmacologic-based interventions for aortic stiffness in end-stage renal disease. Kidney Int Rep. 2019;4(8):1109-21. doi: 10.1016/j.ekir.2019.05.011.

69) Kaur M, Lal C, Bhowmik D, Jaryal AK, Deepak KK, Agarwal SK. Reduction in augmentation index after successful renal transplantation. Clin Exp Nephrol. 2013;17(1):134-9. doi: 10.1007/s10157-012-0653-z.

70) Korogiannou M, Xagas E, Marinaki S, Sarafidis P, Boletis JN. Arterial stiffness in patients with renal transplantation; associations with co-morbid conditions, evolution, and prognostic importance for cardiovascular and renal outcomes. Front Cardiovasc Med. 2019;6:67. doi: 10.3389/fcvm.2019.00067.
Publicado
2020-09-16
Cómo citar
1.
Inserra F, Lavenia G, Forcada P, Castellaro Bello C. La vasculatura sistémica en la enfermedad renal crónica. Tercera parte. Rev Nefrol Dial Traspl. [Internet]. 16 de septiembre de 2020 [citado 28 de marzo de 2024];40(3):251-67. Disponible en: http://vps-1689312-x.dattaweb.com/index.php/rndt/article/view/539
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Artículo de Revisión