From the Guidelines
Increased systemic vasoconstriction is indeed a key change in the perpetuating process stage of Chronic Kidney Disease (CKD), as it contributes to the progression of kidney damage and decline in renal function. As stated in the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1, hypertension is a common comorbidity in patients with CKD, affecting 67% to 92% of patients, and its presence can accelerate further kidney injury. The guideline highlights the importance of treating hypertension to prevent further kidney functional decline, and recommends a blood pressure target of <130/80 mm Hg for all patients with CKD, based on the results of the SPRINT study.
Some key points to consider in the management of CKD include:
- The use of antihypertensive medications that target vasoconstriction, such as RAAS inhibitors like ACE inhibitors (e.g., lisinopril, enalapril) and ARBs (e.g., losartan, valsartan), which help reduce systemic vasoconstriction, lower intraglomerular pressure, and slow CKD progression 1.
- The importance of monitoring serum creatinine and albuminuria in patients with CKD, as these can indicate kidney damage and guide treatment decisions 1.
- The need to avoid combination therapy with an ACE inhibitor and an ARB, due to the increased risk of hyperkalemia and hypotension, and lack of evidence supporting this approach 1.
Overall, the management of CKD requires a comprehensive approach that includes blood pressure control, reduction of proteinuria, and careful monitoring of kidney function, with the goal of slowing disease progression and reducing the risk of cardiovascular complications. The use of RAAS inhibitors, such as ACE inhibitors and ARBs, is a cornerstone of CKD management, as they help reduce systemic vasoconstriction and slow kidney damage.
From the Research
Systemic Vasoconstriction in Chronic Kidney Disease (CKD)
- Increased systemic vasoconstriction is a complex process that can be influenced by various factors, including the renin-angiotensin system (RAS) and the use of certain medications such as angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) 2, 3, 4, 5, 6.
- The relationship between systemic vasoconstriction and CKD progression is not fully understood, but it is known that increased vasoconstriction can lead to decreased renal blood flow and glomerular filtration rate, potentially exacerbating CKD 4, 5.
Role of RAS Inhibitors in CKD
- RAS inhibitors, including ACEIs and ARBs, are commonly used to treat CKD and have been shown to slow disease progression and reduce the risk of kidney failure and cardiovascular events 2, 5, 6.
- The use of RAS inhibitors can also affect systemic vasoconstriction, with some studies suggesting that these medications can reduce vasoconstriction and improve renal blood flow 3, 4.
Impact of Systemic Vasoconstriction on CKD Outcomes
- Increased systemic vasoconstriction has been associated with poorer outcomes in CKD patients, including increased risk of kidney failure and cardiovascular events 4, 5.
- However, the exact mechanisms by which systemic vasoconstriction contributes to CKD progression are not fully understood and require further study 2, 6.
Perpetuating Process Stage of CKD
- The perpetuating process stage of CKD refers to the ongoing processes that contribute to disease progression, including systemic vasoconstriction, inflammation, and fibrosis 2, 4, 5.
- Increased systemic vasoconstriction can be considered a change in the perpetuating process stage of CKD, as it can contribute to decreased renal blood flow and glomerular filtration rate, potentially exacerbating disease progression 4, 5.