Диуретики при хронической болезни почек

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.

хроническая болезнь почек, петлевые диуретики, калийсберегающие диуретики, тиазидовые диуретики, диализ

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