- 期刊
鈣離子通道阻斷劑在慢性腎疾病的角色
The Role of Calcium Channel Blockers in Chronic Kidney Disease
摘要
慢性腎疾病(chronic kidney disease, CKD)是一種慢性、進行性的腎臟病，根據衛生署統計，2003年慢性腎疾病高居台灣第八大死因，因此如何延緩慢性腎疾病進展至末期腎病(end-stage renal disease, ESRD)，是個相當重要的議題。 Angiotensin-converting enzyme inhibitors(ACEIs)或angiotensin receptor blockers(ARBs)在高血壓伴有腎病變的患者被建議作為首選用藥。但除了ACEIs或ARBs外，是否有其他藥物亦具有腎臟保護作用呢？根據動物實驗及臨床研究發現，無論是否患有糖尿病，nondihydropyidine(NDHP)類鈣離子通道阻斷劑，除了降壓作用外，亦有降低蛋白尿的效果。對於無法耐受ACEIs或ARBs的患者，我們可以考慮使用NDHP類鈣離子通道阻斷劑來控制血壓及保護腎臟。而dihydropyridine(DHP)類鈣離子通道阻斷劑在慢性腎疾病的角色，僅限於已使用ACEIs或ARBs但需要達到更佳血壓控制的病患。此外，ACEIs或ARBs與NDHP類鈣離子通道阻斷劑合併使用，比單一藥物治療具有較佳的降蛋白尿及降壓作用。
並列摘要
Chronic kidney disease (CKD) is a progressive renal disease. According to the data of Department of Health, Executive Yuan, CKD was the eighth leading cause of death in Taiwan in 2003. How to delay the progression of CKD to end-stage renal disease (ESRD) is an important issue. Angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) are the first choice for the treatment in CKD patients with hypertension. Are there alternative drugs to ACEIs or ARBs for renoprotection? Animal studies and clinical trials demonstrated that nondihydropyridine calcium channel blockers (NDHP CCBs), in addition to blood pressure control, could reduce the proteinuria in the presence or absence of diabetes. In the patients unable to tolerate ACEIs and/or ARBs, we can consider the use of NDHP CCBs for the management of blood pressure and renoprotection. Dihydropyridine calcium channel blockers (DHP CCBs) in CKD should be restricted to further lower blood pressure in patients unsatisfactory with ACEIs or ARBs. The combination of ACEIs or ARBs and NDHP CCBs is more favorable in alleviating proteinuria and has better blood pressure control than monotherapy.