Granata Antonio, Insalaco Monica, Di Nicolò Pierpaolo, Scarfia Viviana R, Russo Leo, D'anna Giuseppe, Lentini Paolo, Fiorini Fulvio, Fatuzzo Pasquale
G Ital Nefrol. 2014 Jan-Feb;31(1).
A large amount of recent epidemiological studies have shown the worldwide growth on the incidence and prevalence of diabetes mellitus type II (DM2), especially in industrialized countries where DM2 is the most frequent cause of chronic kidney disease. Diabetic nephropathy progression to ESRD (End Stage Renal Disease) may be slowed down only with a tight glycemic control, since no hypoglycemic drugs have been shown to possess renoprotective effects. Treatment with oral hypoglycemic agents should be closely and regularly monitored in patients with diabetic nephropathy since the decline of renal function below 60 ml/min of glomerular filtration rate (GFR) could cause multiple pharmacokinetic alterations. It may expose the patient to serious side effects if cautious dose reduction or even withdrawal of these drugs is not considered. Pharmacological approaches to the treatment of diabetes type 2 include the traditional oral hypoglycemic drugs (insulin sensitizers, insulin secretagogues and drugs inhibiting the absorption of glucose), incretin system drugs (orally or intravenously administered) and insulin therapy, if these drugs are insufficient or are contraindicated. The objective of this review is to evaluate the evidence regarding the use of oral hypoglycemic agents (with particular attention to the DPP-4 inhibitors) in diabetes type 2 with chronic kidney disease stage III- IV and ESRD, while in case of eGFR > 60 ml / min no dosage adjustment is usually required.
近期大量流行病学研究表明，全球范围内2型糖尿病（DM2）的发病率和患病率呈上升趋势，尤其是在工业化国家，DM2是慢性肾病最常见的病因。只有严格控制血糖，糖尿病肾病进展至终末期肾病（ESRD）的速度才可能放缓，因为尚无降糖药物被证明具有肾脏保护作用。糖尿病肾病患者使用口服降糖药时应密切且定期监测，因为肾小球滤过率（GFR）低于60 ml/min时肾功能下降可能导致多种药代动力学改变。如果不考虑谨慎减少剂量甚至停用这些药物，可能会使患者面临严重的副作用。2型糖尿病的药物治疗方法包括传统口服降糖药（胰岛素增敏剂、胰岛素促泌剂和抑制葡萄糖吸收的药物）、肠促胰素系统药物（口服或静脉给药）以及胰岛素治疗（如果这些药物不足或禁忌使用）。本综述的目的是评估在慢性肾病III - IV期和ESRD的2型糖尿病患者中使用口服降糖药（尤其关注二肽基肽酶-4抑制剂）的证据，而当估算肾小球滤过率（eGFR）> 60 ml / min时，通常无需调整剂量。
