Nasri Hamid, Rafieian-Kopaei Mahmoud
Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
Medical Plants Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran.
J Res Med Sci. 2015 Nov;20(11):1112-20. doi: 10.4103/1735-1995.172845.
Nowadays, diabetes mellitus (DM) and hypertension are considered as the most common causes of end-stage renal disease (ESRD). In this paper, other than presenting the role of DM in ESRD, glucose metabolism and the management of hyperglycemia in these patients are reviewed. Although in several large studies there was no significant relationship found between tight glycemic control and the survival of ESRD patients, it is recommended that glycemic control be considered as the main therapeutic goal in the treatment of these patients to prevent damage to other organs. Glycemic control is perfect when fasting blood sugar is less than 140 mg/dL, 1-h postprandial blood glucose is less than 200 mg/dL, and glycosylated hemoglobin (HbA1c) is 6-7 in patients with type 1 diabetes and 7-8 in patients with type 2 diabetes. Administration of metformin should be avoided in chronic renal failure (CRF) because of lactic acidosis, the potentially fatal complication of metformin, but glipizide and repaglinide seem to be good choices.
如今，糖尿病（DM）和高血压被认为是终末期肾病（ESRD）最常见的病因。在本文中，除了阐述糖尿病在终末期肾病中的作用外，还对这些患者的糖代谢及高血糖管理进行了综述。尽管在多项大型研究中未发现严格血糖控制与终末期肾病患者生存率之间存在显著关联，但仍建议将血糖控制视为治疗这些患者的主要治疗目标，以防止对其他器官造成损害。当空腹血糖低于140mg/dL、餐后1小时血糖低于200mg/dL且糖化血红蛋白（HbA1c）在1型糖尿病患者中为6 - 7、在2型糖尿病患者中为7 - 8时，血糖控制较为理想。由于乳酸酸中毒这一二甲双胍潜在的致命并发症，慢性肾衰竭（CRF）患者应避免使用二甲双胍，但格列吡嗪和瑞格列奈似乎是不错的选择。
