Pharmacotherapy of chronic renal failure

The frequency of comorbidity in patients with chronic renal failure is quite high, more than 25%.

And this is a significant factor in the increased risk of developing such adverse events as complications, which significantly reduce the quality of treatment of the underlying disease, and this factor is also the cause of frequent hospitalizations, progression of heart and kidney failure, and sudden death.

Read in this article on estet-portal.com what are the approaches to the treatment of chronic renal failure in conditions of comorbidity.

Combined pathologies in renal failure

Among the comorbid conditions that significantly worsen the process of pharmacotherapy of renal failure are chronic cardiovascular diseases and, as a result of the progression of water-salt balance disorders, the formation of blood stasis in the lower extremities, which can provoke such dangerous consequences of renal failure as thromboembolic complications .

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This significantly changes the approach to pharmacotherapy, since in conditions of complications of renal failure, it is necessary to take into account the functioning of the cardiovascular system. Scientific evidence indicates that heart failure in renal dysfunction is nothing more than an inability of the heart to pump enough blood to meet the body's metabolic needs.

This is a global problem of cardiology, since it concerns almost all sections of clinical cardiology and can be the main manifestation of not only renal failure, but also almost all heart diseases, including coronary atherosclerosis, cardiac arrhythmias and cardiomyopathy.

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New approaches to the pharmacotherapy of renal failure

Special attention deserves a new class of drugs for the pharmacotherapy of renal failure in conditions of combined pathology of the cardiovascular system, capable of providing blockade of neprilysin and angiotensin II receptors.

A new approach to understanding the pathogenesis of heart failure in conditions of renal failure, after a detailed clarification of the interaction of the main active participants in the compensatory mechanisms for the development of these pathologies, is the reninangiotensin system (RAAS) and the sympathoadrenal system (SAS).

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One of the active players in this system is neprilysin, which plays an important role in regulating the adaptive response of the cardiovascular system to pathological factors that develop in renal failure. As an endopeptidase, it is able to degrade a number of endogenous vasoactive peptides: natriuretic peptide (all types), bradykinin and adrenomedulin.

It is these biological substances that play a significant role in providing natriuresis, vasodilation and significantly affect the formation of compensatory reactions in heart and kidney failure.

As it turned out, pharmacotherapy with the suppression of neprilysin activity can significantly increase the level of these peptides and significantly affect natriuresis and vasodilation and ultimately cause a decrease in the manifestations of cardiac dysfunction in renal failure.

However, later it turned out that neprilysin, being a universal destroyer of adaptive counterfactors, primarily tissue natriuretic peptides, leads to a higher activation of the RAAS, since it helps to maintain blood circulation volume. Thus, a vicious circle is formed, and if normally this does not cause significant pathological changes, then in the case of heart disease it leads to a breakdown in adaptive capabilities and rapid decompensation.

Combined pharmacotherapy for renal failure

This suggested a possible combined effect on the activation of the RAAS, SAS and neprilysin to balance compensatory factors and reduce their negative impact. It turned out that the combination of valsartan + sacubitril significantly increases the effectiveness of treatment in chronic heart and kidney failure.

Combined pharmacotherapy (a complex combination of two ingredients as a holistic medicinal form!) acts indirectly with simultaneous suppression of the activity of neprilysin, due to the action of sacubitril and blockade of type 1 angiotensin II receptors through valsartan. It is this combination that has led to a significant improvement in the pharmacotherapy of patients with combined pathology of heart and kidney failure compared to enalapril and other drugs that are traditionally used for its treatment.

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Thus, clinicians have received a fairly effective drug for the treatment of patients with chronic renal failure with concomitant cardiac pathology. It turned out to be interesting that the drug can also be used in stabilized patients before discharge to outpatient treatment, as well as in case of need to replace enalapril or the impossibility of taking it, or as a first-line drug in patients with a manifest form of heart and kidney failure.

However, the most important thing to remember is that the drug is a definite investment in the safety and guarantee of the effectiveness of the treatment of patients with initial manifestations of renal failure with a history of heart failure.

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