Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, MA 02115, USA.
Med Clin North Am. 2013 Jan;97(1):135-56. doi: 10.1016/j.mcna.2012.11.001.
Hyperglycemia management in chronic kidney disease (CKD) patients presents difficult challenges, partly due to the complexity involved in treating these patients, and partly due to lack of data supporting benefits of tight glycemic control. While hyperglycemia is central to the pathogenesis and management of diabetes, hypoglycemia and glucose variability also contribute to outcomes. Multiple agents with different mechanisms of action are now available; some can lower glucose levels without the risk of hypoglycemia. This article reviews metabolic changes present in kidney impairment/failure, current views about glycemic goals, and treatment options for the diabetic patient with CKD.
慢性肾脏病（CKD）患者的血糖管理面临着诸多挑战，这部分是由于治疗这些患者的复杂性，部分是由于缺乏支持严格血糖控制获益的数据。虽然高血糖是糖尿病发病机制和治疗的核心，但低血糖和血糖变异性也会影响结局。目前有多种作用机制不同的药物可供选择；有些药物可以降低血糖水平，而不会有低血糖的风险。本文综述了肾功能损害/衰竭时的代谢变化、目前对血糖目标的看法，以及 CKD 糖尿病患者的治疗选择。
