avkАрхивъ внутренней медициныThe Russian Archives of Internal Medicine2226-67042411-6564“SINAPS” LLC10.20514/2226-6704-2020-10-1-10-20avk-996Research ArticleОБЗОРНЫЕ СТАТЬИREVIEW ARTICLESДиуретики при хронической болезни почекDiuretics in chronic kidney diseaseДядыкА. И.DyadykA. I.

Донецк

Donetsk

https://orcid.org/0000-0003-3984-8482ТарадинГ. Г.TaradinG. G.

Геннадий Геннадьевич Тарадин

Донецк

Donetsk

taradin@inbox.ruhttps://orcid.org/0000-0001-6538-9676СулиманЮ. В.SulimanYu. V.

Донецк

Donetsk

https://orcid.org/0000-0002-3754-965XЗборовскийС. Р.ZborovskyyS. R.

Донецк

Donetsk

МеркурьевВ. И.MerkurievV. I.

Донецк

Donetsk

ГОО ВПО «Донецкий национальный медицинский университет им. М. Горького»УкраинаState Educational Organization of Higher Professional Education «M. Gorky Donetsk National Medical University»UkraineГОО ВПО «Донецкий национальный медицинский университет им. М. Горького»; ГУ «Институт неотложной и восстановительной хирургии им. В.К. Гусака»УкраинаState Educational Organization of Higher Professional Education «M. Gorky Donetsk National Medical University»; State Institution «V.K. Gusak Institute of Urgent and Recovery Surgery»UkraineКУ «Центральная городская клиническая больница № 1»УкраинаClinical Institution «Central City Clinical Hospital № 1»Ukraine2020300120201011020Copyright © Дядык А.И., Тарадин Г.Г., Сулиман Ю.В., Зборовский С.Р., Меркурьев В.И., 20202020Дядык А.И., Тарадин Г.Г., Сулиман Ю.В., Зборовский С.Р., Меркурьев В.И.Dyadyk A.I., Taradin G.G., Suliman Y.V., Zborovskyy S.R., Merkuriev V.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.medarhive.ru/jour/article/view/996

В статье рассматриваются вопросы диуретической терапии у пациентов с хронической болезнью почек. Затрагивается тема фармакокинетики диуретиков, проблема диуретической резистентности, показана тактика применения тиазидных и петлевых диуретиков у больных с различными стадиями хронической болезни почек согласно рекомендациям National Kidney Foundation Kidney Disease Outcomes Quality Initiative. Особое внимание уделяется назначению этих препаратов пациентам с терминальной почечной недостаточностью, а также, находящимся на заместительной почечной терапии (гемодиализ). Диуретикам отводится важное место в ведении больных с хронической болезнью почек при развитии артериальной гипертензии и увеличении экстрацеллюлярного объема жидкости. При нарушении функции почек ведущее место отводится петлевым диуретикам. Их комбинация с тиазидными диуретиками позволяет увеличивать диуретический эффект. Показана способность петлевых диуретиков снижать нарастание массы тела между сеансами гемодиализа. Приводятся результаты клинических исследований, посвященных оценке эффективности использования диуретиков на фоне снижения резидуальной почечной функции. Сообщается о влиянии калийсберегающих диуретиков на частоту развития кардиоваскулярных осложнений, развитие гиперкалиемии у пациентов, находящихся на диализном лечении. Указывается на важность продолжения интенсивного изучения возможности применения антагонистов минералокортикоидных рецепторов, в частности спиронолактона, эплеренона и финеренона с целью снижения кардиоваскулярных осложнений и летальности.

The issues of diuretic therapy in patients with chronic kidney disease, pharmacokinetics of diuretics, the problem of diuretic resistance, the tactics of using thiazides and loop diuretics in patients with various stages of chronic kidney disease, according to the recommendations of the National Kidney Foundation Kidney Disease Outcomes Quality Initiative are discussed in the article. Particular attention is paid to the prescription of this group of drugs to patients with end stage renal disease, as well as those undergoing renal replacement therapy (hemodialysis).Diuretics play an important role in the management of patients with chronic kidney disease with the development of hypertension and an increased extracellular fluid volume. In case of impaired renal function leading place is given to loop diuretics. Their combination with thiazide diuretics can increase the diuretic effect. The results of clinical trials assessing the effectiveness of the use of diuretics during decline of residual renal function are provided. It is reported about the effect of potassium-sparing diuretics on the incidence of cardiovascular complications, the development of hyperkalemia in patients undergoing dialysis treatment. The importance of continuation of intensive study about the possibility of antagonists of mineralocorticoid receptors usage, in particular the spironolactone, eplerenone, and finerenone in order to reduce cardiovascular complications and mortality, is indicated.

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The authors declare that there are no conflicts of interest present.