慢性肾脏病患者的心律失常：为抗心律失常药物治疗肾功能衰竭的影响

Title:Cardiac Arrhythmias in Patients with Chronic Kidney Disease: Implications of Renal Failure for Antiarrhythmic Drug Therapy

Volume: 23 Issue: 19

Author(s): Tatjana S. Potpara, Vera Jokic, Nikolaos Dagres, Francisco Marin, Milica S. Prostran, Carina Blomstrom-Lundqvist and Gregory Y.H. Lip

Affiliation:

关键词: 心律失常，慢性肾脏病，药物剂量，抗心律失常药物，危险因素，房颤，室性心律失常、心源性猝死。

摘要: The kidney has numerous complex interactions with the heart, including shared risk factors (e.g., hypertension, dyslipidemia, etc.) and mutual amplification of morbidity and mortality. Both cardiovascular diseases and chronic kidney disease (CKD) may cause various alterations in cardiovascular system, metabolic homeostasis and autonomic nervous system that may facilitate the occurrence of cardiac arrhythmias. Also, pre-existent or incident cardiac arrhythmias such as atrial fibrillation (AF) may accelerate the progression of CKD.

Patients with CKD may experience various cardiac rhythm disturbances including sudden cardiac death. Contemporary management of cardiac arrhythmias includes the use of antiarrhythmic drugs (AADs), catheter ablation and cardiac implantable electronic devices (CIEDs). Importantly, AADs are not used only as the principal treatment strategy, but also as an adjunct therapy in combination with CIEDs, to facilitate their effects or to minimize inappropriate device activation in selected patients. Along with their principal antiarrhythmic effect, AADs may also induce cardiac arrhythmias and the risk for such proarrhythmic effect(s) is particularly increased in patients with reduced left ventricular systolic function or in the setting of electrolyte imbalance. Moreover, CKD itself can induce profound alterations in the pharmacokinetics and pharmacodynamics of many drugs including AADs, thus facilitating the drug accumulation and increased exposure. Hence, the use of AADs in patients with CKD may be challenging.

In this review article, we provide an overview of the characteristics of arrhythmogenesis in patients with CKD with special emphasis on the complexity of pharmacokinetics and risk for proarrhythmias when using AADs in patients with cardiac arrhythmias and CKD.

Cite this article as:

Tatjana S. Potpara, Vera Jokic, Nikolaos Dagres, Francisco Marin, Milica S. Prostran, Carina Blomstrom-Lundqvist and Gregory Y.H. Lip , Cardiac Arrhythmias in Patients with Chronic Kidney Disease: Implications of Renal Failure for Antiarrhythmic Drug Therapy, Current Medicinal Chemistry 2016; 23 (19) . https://dx.doi.org/10.2174/0929867323666160309114246