RESUMEN
PURPOSE OF REVIEW: To present the available data on the risks and benefits for ACEi/ARB usage in patients with advanced CKD. RECENT FINDINGS: It has been well established that ACEi/ARB use is beneficial in patients with mild-to-moderate CKD, especially in patients with proteinuria. The majority of available data includes patients with diabetes mellitus. However, data in individuals with advanced CKD are limited. Additionally, data available for this subset of patients is conflicting and the definition of advanced CKD varies across clinical trials. SUMMARY: On the basis of our literature review, evidence suggests continuing ACEi/ARB therapy in patients with advanced CKD (eGFR less than 15âml/min/1.73âm) unless hyperkalemia ensues unresponsive to therapy, hypotension develops or have unusually rapid worsening of eGFR (not usual progressive decline). These patients should be monitored closely. There is not enough data to support starting ACEi/ARBs de novo in patients with advanced CKD (eGFR less than 15âml/min/1.73âm). If RAS blockade is started de novo in this subgroup, we recommend close monitoring.
Asunto(s)
Antagonistas de Receptores de Angiotensina/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Antihipertensivos/uso terapéutico , Tasa de Filtración Glomerular , Fallo Renal Crónico/fisiopatología , Antagonistas de Receptores de Angiotensina/efectos adversos , Inhibidores de la Enzima Convertidora de Angiotensina/efectos adversos , Antihipertensivos/efectos adversos , Humanos , Hiperpotasemia/inducido químicamente , Hipotensión/inducido químicamente , Fallo Renal Crónico/complicaciones , Proteinuria/etiología , Sistema Renina-Angiotensina , Medición de RiesgoRESUMEN
Coating the interior surface of a fused-silica capillary with a polymeric material has long been used in capillary electrophoresis (CE) to reduce or eliminate electroosmotic flow and suppress adsorption. A cycloaliphatic epoxide-based resin was bonded to silane treated capillaries and crosslinked with a curing agent. The epoxy resin coating significantly reduced electroosmotic flow over a pH range of 3-10. This coating was sufficiently hydrophilic to suppress protein adsorption. The epoxy resin coated capillary was used to separate several acidic and basic proteins and peptides. Separation efficiencies greater than 400,000 theoretical plates were achieved. The relative standard deviations in migration times for proteins were <0.8%. Speed and simplicity are important advantages of the coating procedure compared to other published coating methods.